Is it okay for a patient with a Nasogastric (NG) tube to drink water from their mouth?

Oral Water Intake for Patients with Nasogastric Tubes

Yes, patients with nasogastric (NG) tubes who can swallow safely may drink water by mouth, as providing fluid and nutrients orally is a basic duty of care when patients express willingness to drink and can do so safely. 1

Assessment of Swallowing Safety

Before allowing oral water intake:

1. Swallowing Assessment is Mandatory

   • A formal dysphagia screening must be completed before any oral intake 1
   • Healthcare providers can perform initial screening before speech language pathologist assessment
   • Water swallow test is a useful screening tool
   • "Wet voice" after swallowing indicates high aspiration risk

2. Risk Factors for Aspiration

   • NG tubes themselves increase aspiration risk by:
     • Disrupting upper and lower esophageal sphincter integrity
     • Increasing frequency of transient lower esophageal sphincter relaxations
     • Desensitizing the pharyngoglottal adduction reflex 2

Guidelines for Safe Oral Water Intake

If swallowing assessment confirms safety:

• Position the patient upright (minimum 30° elevation) during drinking and for at least 30 minutes afterward 3
• Start with small volumes - 3-5 ml of water has been shown to be effective for safely assessing swallowing ability in patients with dysphagia 4
• Monitor for signs of aspiration during and after drinking:
  • Coughing
  • Choking
  • Voice changes
  • Respiratory distress

Considerations for Different Patient Scenarios

1. Patients who can self-regulate fluid intake:

   • Allow ad libitum access to water
   • Patient's own thirst sensation is often more accurate than medical calculations 1

2. Patients with cognitive impairment:

   • Offer water frequently in addition to regular fluid intake
   • Monitor weight, fluid balance, and biochemistry closely 1

3. Patients with swallowing difficulties:

   • Consider thickened liquids if dysphagia is contributing to aspiration risk 3
   • Implement oral care protocols to reduce bacterial load in the mouth 3

NG Tube Management During Oral Intake

• Continue to check NG tube position before each use using pH testing 1
• Schedule oral water intake away from tube feeding times to reduce aspiration risk 3
• For medication administration through NG tube:
  • Flush with at least 30 mL of water before and after medication administration 3
  • Avoid crushing medications not designed to be crushed 5

Cautions and Contraindications

• Avoid oral intake if patient shows signs of:

  • Severe dysphagia
  • Frequent aspiration
  • Impaired consciousness
  • Recent acute variceal bleeding (within 3 days) 1

• Monitor for respiratory complications:

  • Increased work of breathing
  • Rhonchi
  • Decreased oxygen saturation 3

Key Pitfalls to Avoid

1. Never assume NG tube presence automatically prohibits oral intake - many patients with NG tubes can safely drink water
2. Don't skip formal swallowing assessment - this is essential before allowing any oral intake
3. Don't allow drinking while lying flat - this significantly increases aspiration risk
4. Don't rely on auscultation alone to check NG tube position - pH testing is more reliable 1

Remember that providing oral hydration when safely possible can significantly improve patient comfort and quality of life while maintaining the ethical duty to provide appropriate fluid when patients express willingness to drink.