How should I remove a nasogastric (or nasoenteric) feeding tube in an alert patient who can sit upright at a 30‑45° angle?

How to Remove a Nasogastric Feeding Tube

To remove a nasogastric or nasoenteric feeding tube, position the patient upright at 30-45 degrees, remove all securing devices (tape or nasal bridle), ask the patient to take a deep breath and hold it, then withdraw the tube in one smooth, continuous motion while the patient holds their breath—this prevents aspiration during removal. 1

Pre-Removal Assessment

Before removing the tube, verify that:

• The patient no longer requires enteral nutrition or has transitioned successfully to adequate oral intake 2
• There is no ongoing indication for gastric decompression 2
• The patient has been assessed for dysphagia if applicable, particularly in stroke patients where 40-78% experience swallowing difficulties 1
• Oral intake has been safely established if nutrition is still needed 2

Step-by-Step Removal Procedure

Patient Positioning

• Position the patient sitting upright at 30-45 degrees to minimize aspiration risk during removal 1
• Ensure the patient is alert and cooperative enough to follow instructions 1

Preparation

• Remove all securing devices completely:
  • Remove adhesive tape from the nose and face 1
  • If a nasal bridle is present (used in 10% of secured tubes to prevent dislodgement), this must be removed first by a trained clinician 1
• Have tissues or towel available to catch any residual tube contents 1
• Consider having suction available if the patient has impaired airway protection 2

Removal Technique

• Instruct the patient to take a deep breath and hold it (or pinch the tube closed if the patient cannot cooperate) 1
• Withdraw the tube in one smooth, continuous, steady motion without pausing 1
• The breath-holding maneuver closes the glottis and prevents aspiration of any residual gastric contents on the tube during withdrawal 1
• Do not apply suction during removal as this can cause mucosal trauma 3

Post-Removal Care

• Inspect the nasal passages for any trauma, erosions, or bleeding that may have occurred from prolonged tube placement 2
• Clean the patient's face and provide mouth care 2
• Monitor for any respiratory distress or signs of aspiration in the immediate post-removal period 1
• Document the removal, tube integrity (ensure the entire tube was removed), and patient tolerance 1

Common Pitfalls and How to Avoid Them

• Never yank or pull the tube rapidly in jerking motions—this increases risk of nasal trauma and patient discomfort 2
• Do not remove the tube while the patient is coughing or gagging—wait until they are calm and can cooperate with breath-holding 1
• Ensure all securing devices are completely removed first—attempting to pull a tube that is still secured can cause significant nasal trauma 1
• For tubes that have been in place >3-4 weeks, inspect carefully for sinusitis or nasal erosions before and after removal 2
• If resistance is encountered during removal, stop and investigate—the tube may be knotted, kinked, or adherent to tissue 2

Special Considerations

• In patients with recent variceal bleeding, nasogastric tube removal should be delayed for at least 3 days after the bleeding episode to avoid rebleeding 2
• For patients requiring continued enteral nutrition beyond 4 weeks, consider transitioning to percutaneous gastrostomy (PEG) rather than repeated nasogastric tube insertions 2
• Approximately 25% of nasogastric tubes are accidentally dislodged or pulled out by patients, so planned removal under controlled conditions is preferable 2
• After removal, if oral intake remains inadequate and enteral nutrition is still needed, reassess whether PEG placement is more appropriate than reinserting another nasogastric tube 2