Nasogastric Tube Replacement Frequency
Long-term NG and nasojejunal tubes should be changed every 4-6 weeks, alternating nostrils with each replacement. 1, 2, 3
Routine Replacement Schedule
Replace NG tubes every 4-6 weeks when used for long-term enteral feeding, swapping the tube to the opposite nostril with each change to prevent nasal complications. 1, 2, 3
This replacement interval applies specifically to fine bore (5-8 French gauge) tubes used for enteral feeding. 1
The 4-6 week timeframe helps prevent complications including nasal pressure injuries, sinusitis, tube degradation, and material breakdown. 3
Daily Management Requirements
Evaluate the need for the NG tube daily and remove it as early as possible when no longer clinically necessary. 1
Check tube position using pH testing (aspirate should be pH <5.5) prior to every use to ensure proper placement. 1, 4
Flush the tube with at least 30 mL of fresh water before and after every feed or medication administration to prevent blockage. 3, 4, 5
When to Replace Earlier Than Scheduled
Replace immediately if the tube becomes blocked and cannot be cleared with warm water flushing or alkaline pancreatic enzyme solution. 1, 3
Replace if the tube develops splits, breakages, or material degradation that compromise function. 1
Replace if there is evidence of nasal damage, erosions, or significant patient discomfort. 3
Transition to Alternative Access
Consider gastrostomy or jejunostomy placement when enteral feeding will be required for more than 4-6 weeks. 1, 2, 3
Some evidence supports considering percutaneous placement as early as 14 days after initiation of enteral feeding. 2
Gastrostomy tubes are associated with lower risk of dislodgement and possibly better quality of life compared to prolonged NG tube use. 3
Common Pitfalls to Avoid
Do not rely on auscultation alone to verify tube placement—always use pH testing or radiographic confirmation. 1, 4
Avoid administering hyperosmolar drugs, crushed tablets, potassium, iron supplements, or sucralfate through the tube as these are particularly likely to cause blockage. 3
Do not use carbonated drinks, pineapple juice, or sodium bicarbonate solution to clear blocked tubes as these may cause tube degradation. 1
Ensure adequate flushing (minimum 30 mL) as insufficient flushing is a leading cause of tube obstruction. 4