What should be included in a nursing care plan (NCP) for a patient with a Nasogastric Tube (NGT)?

Nursing Care Plan for Nasogastric Tube (NGT)

A comprehensive nursing care plan for patients with nasogastric tubes should include verification of tube placement, prevention of complications, proper feeding protocols, skin care, and patient education to ensure optimal outcomes and reduce morbidity and mortality. 1

Initial Assessment and Placement Verification

• Confirm correct NGT placement before initiating any feeding or medication administration through radiographic confirmation, which is the gold standard method 1
• Alternative verification methods include aspiration of gastric contents and measurement of gastric pH, but these should not replace radiographic confirmation for initial placement 1
• Measure insertion length using appropriate methods, as the traditional nose-earlobe-xiphoid method may result in tubes that are too short, increasing aspiration risk 2
• Document tube position, size, and insertion date in the patient's chart 1

Feeding Management

• Begin feeding immediately after proper NGT placement has been confirmed according to the established nutritional care plan 3
• For patients with uncomplicated NGT placement, there is no need to dilute feeds unless additional water is specifically required for hydration 3
• Monitor for signs of feeding intolerance such as nausea, vomiting, abdominal distension, or diarrhea 3
• Maintain proper hydration by administering maintenance fluids until dysphagia assessment is complete in patients who are nil per os 3
• Calculate nutritional requirements considering wound losses and feeding capacity with input from a dietitian 3

Tube Maintenance and Care

• Flush the tube with 40 ml of water after each medication administration or feeding to prevent blockage 1
• Change the dressing regularly and inspect the insertion site for irritation or signs of infection 1
• Secure the NGT properly to prevent accidental dislodgement, which occurs in 40-80% of cases without proper fixation 1, 4
• Consider specialized securing methods such as using a low-adherent film as a contact layer with full-adherent tape securing the tube to the film (avoiding direct skin contact) for patients at high risk of skin breakdown 3
• Replace long-term NGTs every 4-6 weeks, alternating nostrils to prevent complications such as pressure injuries, sinusitis, and tube degradation 5

Complication Prevention and Management

• Assess for dysphagia before oral intake, especially in stroke patients, as 40-78% experience dysphagia which can lead to aspiration pneumonia 3
• Monitor for respiratory complications by assessing breathing patterns and oxygen saturation regularly 6
• Check for signs of tube displacement before each use by verifying external tube markings and testing gastric pH 1
• Implement measures to prevent tube blockage by administering medications in liquid form when possible and avoiding crushed tablets, potassium, iron supplements, and sucralfate 5
• Monitor for signs of infection at the insertion site and implement appropriate antimicrobial treatment if needed 3

Patient and Caregiver Education

• Provide comprehensive education to patients and caregivers on tube management, feeding administration, and troubleshooting before discharge 3
• Ensure patients and caregivers can demonstrate competency in feed administration, equipment handling, and basic troubleshooting in case of tube or equipment failure 3
• Instruct on proper positioning during feeding (head elevated 30-45 degrees) to reduce aspiration risk 1
• Teach signs and symptoms that require immediate medical attention, such as difficulty breathing, tube displacement, or signs of infection 6
• For home care, provide specific instructions on the quantity and type of enteral feeding, total fluid requirements, duration of administration, and proper tube fixation 5

Special Considerations

• For patients requiring enteral nutrition beyond 4-6 weeks, consider more permanent options like percutaneous endoscopic gastrostomy (PEG) 3
• In patients with severe dysphagia, especially stroke patients, if NGT is poorly tolerated or frequently dislodged, consider early PEG placement 7
• For patients with maxillofacial trauma, nasal obstruction, coagulopathy, or recent nasal surgery, consider orogastric tube insertion instead of NGT 7
• In neonates with epidermolysis bullosa, use NGTs rather than orogastric tubes due to increased risk of oral mucosal damage with orogastric tubes 3
• For patients requiring jejunal feeding, implement a graduated program starting at low rates (10 mL/h) and gradually increasing to target rates 3