Can a patient with a nasogastric (NG) tube use an incentive spirometer?

Use of Incentive Spirometer in Patients with Nasogastric Tubes

Patients with nasogastric tubes can and should use incentive spirometry as it helps prevent pulmonary complications without interference from the NG tube. This practice is supported by clinical guidelines and evidence focusing on respiratory care in hospitalized patients.

Benefits of Incentive Spirometry with NG Tubes

• Incentive spirometry increases alveolar ventilation and functional residual capacity, which is particularly important for patients with NG tubes who may be at higher risk for respiratory complications 1
• Patients with NG tubes are at increased risk for pneumonia, which is a significant cause of morbidity and mortality, especially in stroke patients and immobile patients 2
• Early mobility and good pulmonary care, including incentive spirometry, can help prevent pneumonia in these high-risk patients 2

Clinical Implementation

Patient Positioning

• Ensure the patient is positioned at a 30° angle or higher during incentive spirometry to reduce the risk of aspiration 3
• The NG tube should be properly secured to prevent dislodgement during the respiratory exercise

Technique

1. Place the incentive spirometer within arm's reach of the patient (device proximity significantly affects correct usage) 4
2. Instruct the patient to:
   • Take a normal breath out
   • Place lips tightly around the mouthpiece (alongside the NG tube)
   • Inhale slowly and deeply through the mouthpiece to raise the flow indicator
   • Hold breath for 3-5 seconds
   • Remove mouthpiece and exhale normally
   • Rest for a few seconds before repeating

Frequency

• Recommend 5-10 breaths per session, every 1-2 hours while awake
• Volume-oriented incentive spirometers are preferred over flow-oriented devices 1

Special Considerations

For Patients with Dysphagia

• Tube-fed patients should be encouraged to maintain oral function as safely possible, including using an incentive spirometer 2
• Even patients with dysphagia and nil-by-mouth status swallow more than 500 ml of saliva per day, so using an incentive spirometer presents no additional risk 2

Cautions

• Monitor for signs of respiratory distress during and after incentive spirometry
• Avoid aggressive use of incentive spirometry in patients with emphysema or bullous lung disease, as this has been associated with pneumothorax in rare cases 5
• Ensure proper education on device use, as studies show that 26.2% of patients fail to use their incentive spirometer correctly 4

Optimizing Success

• Provide brief educational interventions, which have been shown to increase patient confidence in using incentive spirometers by 73.8% 4
• Ensure the device is always within arm's reach of the patient 4
• Explain the benefits of the device to improve compliance, as perceived benefit is a significant determinant of successful use 4

The presence of an NG tube is not a contraindication to incentive spirometry. In fact, given the increased risk of pulmonary complications in patients with NG tubes, incentive spirometry becomes even more important as a preventive measure against atelectasis and pneumonia.