5.2 Nasogastric & Gastrostomy Tube Care

Nasogastric & Gastrostomy Tube Care

NCCT's test plan includes "provide care for patients with gastric and NG tubes." These tubes let patients receive nutrition when they cannot swallow safely or let the team drain the stomach after surgery or during a bowel obstruction. The tubes themselves are managed by licensed staff, but the PCT provides much of the hands-on care that keeps them safe.

Types of Enteral Tubes

The PCT's Role

Preventing Aspiration

Aspiration of formula into the lungs can cause pneumonia and respiratory failure.

• Keep the head of the bed up at least 30 degrees, and often 30 to 45 degrees, during continuous feedings and for about 30 to 60 minutes after a bolus feeding, unless the provider orders otherwise.
• Before lowering the head of the bed for repositioning or a bed bath, tell the nurse. Many facilities have the nurse pause the feeding first, then restart it once the patient is back up.
• Stop and report at once if the patient coughs or chokes during a feeding, has new trouble breathing, a drop in SpO2, vomiting, a distended or firm abdomen, or complains of fullness. If the patient vomits, turn them to the side to protect the airway and call the nurse; pause the pump only if policy allows.

Keeping the Tube in Place

• At the start of the shift and after repositioning, check the tube's external length marking at the nostril (or at the skin for a G-tube) against the documented mark.
• If the mark has moved, the tube looks longer, or it is coiled in the patient's mouth, do not push it back in. A tube that has migrated may sit in the esophagus or lungs. Stop per policy and notify the nurse.
• Secure the tube to the gown with tape or a clip, leaving slack so turning or sitting up does not pull it.
• Confused patients may pull at tubes. Report this to the nurse, who may use distraction, a binder over a G-tube, or other measures. Mitts and restraints require an order (Section 2.2).

Nares and Mouth Care for NG Tubes

• Clean around the nostril with water and a cotton-tipped applicator, and inspect it for redness or breakdown. A tube pressing against the rim of the nostril can cause a medical device-related pressure injury; report pressure marks so the nurse can re-secure the tube.
• Patients with NG tubes are often NPO and breathe through the mouth, so provide frequent oral care (commonly every 2 to 4 hours per policy) and apply water-soluble lip moisturizer. Oral care also lowers the risk of pneumonia.
• Keep the NPO sign posted and give no food or drink unless the diet order allows it.

NG Tubes Connected to Suction

• Measure the drainage as output when the canister is emptied or changed according to policy, and record it on the intake and output sheet.
• Note the color: clear, pale yellow, or green (bile) is typical of gastric contents. Coffee-ground or bright red drainage suggests bleeding and is reported immediately.
• Report little or no drainage when the abdomen is becoming distended or the patient is nauseated, because the tube may be blocked.
• Never change the suction setting or disconnect the tube.

Gastrostomy (G-Tube / PEG) Site Care

• Clean the skin around the site daily, or as ordered, with mild soap and water (or saline if ordered), then pat it completely dry.
• Look for redness, swelling, warmth, drainage, leaking formula, bleeding, or overgrown pink tissue at the stoma, and report any of them.
• If a dressing is ordered, use a pre-split drain sponge, not a cut gauze pad, which can shed fibers into the stoma.
• Do not rotate or adjust the external bumper unless trained and permitted; a bumper that is too tight can cause skin breakdown, and one that is too loose can let the tube slide.
• If a G-tube comes out, cover the site with clean gauze and notify the nurse immediately. The opening can start to close within hours, and replacement may need to be done quickly.

Intake and Output

Enteral formula and water flushes count as intake, and NG drainage, vomitus, and diarrhea count as output (Section 4.5). Tube-fed patients are prone to dehydration and diarrhea, so report thirst, dry mucous membranes, decreased urine, or frequent loose stools.

Clinical Trap: The Flat Bed Bath

A PCT lowers the head of the bed flat to give a bed bath while a continuous feeding runs at 60 mL per hour. The patient begins coughing and becomes short of breath. The correct approach was to tell the nurse before lowering the head of the bed so the feeding could be paused, keep the head of the bed as high as the task allows, and keep the patient on their side if coughing starts.