From the Guidelines
Nasogastric (NG) tubes should be removed when they are no longer clinically necessary, such as when the patient can tolerate oral intake, has return of normal bowel function, or when gastric decompression is no longer needed, as prolonged placement increases the risk of complications including patient discomfort, mucosal damage, and potential for aspiration 1.
Indications for Removal
The following are indications for removal of a Nasogastric (NG) tube:
- The patient can tolerate oral intake
- Return of normal bowel function (passing flatus or stool)
- Gastric decompression is no longer needed
- Resolution of the original condition requiring placement (such as bowel obstruction, ileus, or need for enteral feeding)
- Significant decrease in gastric output (less than 100-200 mL over 24 hours)
- Transitioning to oral medications or alternate feeding routes
- Development of complications, including nasal erosion or necrosis, inadvertent pulmonary placement, sinusitis, esophageal or gastric erosions, or tube obstruction that cannot be cleared
Considerations for Long-term Feeding Needs
For patients with long-term feeding needs, consider replacing the NG tube with a more permanent feeding solution like a gastrostomy tube, as seen in a study where PEG feeding was compared to nasogastric tube feeding in adults with swallowing disturbances 1.
Balancing Risks and Benefits
The decision to remove an NG tube should balance the risks of continued placement against the benefits, taking into account the patient's individual needs and medical condition, as well as the potential for complications, such as those reported in a study on the effects of early nutrition via PEG in mechanically ventilated patients with stroke or head injury 1.
From the Research
Indications for Removal of a Nasogastric (NG) Tube
The following are indications for removal of a Nasogastric (NG) tube:
- Nasogastric tube syndrome (NGTS) characterized by throat pain and abductor dysfunction of vocal cords due to the presence of the NGT 2, 3
- Acute upper airway obstruction caused by vocal cord paralysis or laryngeal infection 3
- Presence of complications such as basal atelectasis, loss of electrolytes, and increased patient morbidity due to prolonged nasogastric intubation 4
- Confirmation of safe oral feeding through videofluoroscopic swallow study (VFSS) in acute stroke patients 5
- Achievement of nutritional requirements through oral alimentation, making the NG tube no longer necessary 6
Specific Conditions for Removal
In certain conditions, the removal of the NG tube may be considered:
- In patients with nasogastric or nasointestinal ileus tubes, removal of the tube is recommended if symptoms of NGTS occur 3
- In acute stroke patients with thin liquid aspiration, removal of the NG tube and change to oral feeding with a food thickener may be safe 5
- In patients undergoing elective bowel surgery, routine use of the nasogastric tube postoperatively may be safely eliminated 4