What is the maximum duration for having a Nasogastric (NG) tube in place?

From the Guidelines

Nasogastric (NG) tubes should typically not be used for more than 4 weeks due to the risk of complications such as sinusitis, and alternative options like percutaneous endoscopic gastrostomy (PEG) tubes should be considered for longer-term enteral access. The duration of NG tube placement varies based on the specific type of tube and individual patient factors, with short-term NG tubes made of polyvinyl chloride (PVC) generally being replaced every 3-7 days, and longer-term silicone or polyurethane tubes remaining in place for up to 4-6 weeks 1. However, the most recent and highest quality study suggests that transnasal tubes are typically not used for more than 3–4 weeks due to the risk of sinusitis 1. Healthcare providers should regularly assess the tube's condition, checking for signs of wear, blockage, or patient discomfort, and the tube should be properly secured to prevent displacement and the insertion site should be cleaned daily. Patients with NG tubes require ongoing monitoring of hydration status, electrolyte balance, and nutritional parameters. If longer-term enteral access is needed, alternative options like PEG tubes should be considered to reduce complications associated with prolonged NG tube placement 1.

Some key considerations for NG tube placement and management include:

• The use of fine bore (5–8 French gauge) NG tubes for enteral feeding in adult hospital patients, unless there is a need for repeated gastric aspiration or administration of high viscosity feeds/drugs via the tube 1
• The importance of checking the position of the NG tube using pH testing prior to every use, and confirming the position of a nasojejunal (NJ) tube by x ray 8–12 hours after placement 1
• The need to avoid NG tube insertion for three days after acute variceal bleeding, and to use only fine bore tubes in such cases 1
• The recommendation to change long term NG and NJ tubes every 4–6 weeks, swapping them to the other nostril, and to consider gastrostomy or jejunostomy feeding for patients who are likely to require enteral feeding for more than 4–6 weeks 1.

Overall, the key priority is to minimize the risk of complications and ensure the best possible outcomes for patients with NG tubes, while also considering the individual patient's needs and circumstances.

From the Research

Duration of Nasogastric Tube Placement

• The duration of a nasogastric (NG) tube can vary depending on the individual patient's needs and medical condition 2.
• According to a study published in 1997, the duration of NG tubes in critically ill patients ranged from 1 to 42 days, with an average of 9 days 2.
• Another study published in 2022 suggests that percutaneous endoscopic gastrostomy (PEG) is a suitable option for patients who need nutritional support for more than 4 weeks, implying that NG tubes may not be suitable for long-term use 3.
• There is no specific guideline on the maximum duration of NG tube placement, but it is generally recommended to consider alternative routes, such as gastrostomy or jejunostomy, if long-term enteral nutrition is required 4, 3, 5.

Complications and Limitations

• NG tubes can be associated with complications, such as inadvertent removal, intolerance to tube feeding, clogging, kinking, and cracking at the tube adapter 2.
• Long-standing NG or nasoenteric feeding tubes are not well tolerated, and alternative routes may be necessary to avoid complications 4.
• The choice of tube placement method and duration of use should be individualized based on the patient's medical condition, nutritional needs, and potential risks and benefits 6, 5.