Pediatric NG Tube Placement/Verification Video for Professionals

Summary

This video, led by pediatric nutrition support nurse Beth Lyman, explains how to safely insert and verify the placement of a nasogastric (NG) feeding tube in children. The video covers the procedure step-by-step, focusing on best practices to ensure proper tube insertion and reduce risks like accidental pulmonary placement, which can cause serious complications. It highlights alternative verification methods to avoid excess radiation from frequent X-rays, and emphasizes patient reactions, especially in pediatric settings, where maintaining a calm approach is essential.

Takeaways

• 🍼 Children receive nasogastric (NG) tubes to deliver food, medication, or fluids directly into their stomachs.
• 🩺 The NG tube is inserted through the nose and guided down the esophagus to the stomach, but can be misplaced into the trachea, which is dangerous.
• ⚠️ Misplacement of the NG tube into the lungs can cause severe complications like sepsis, respiratory failure, or death if feeding begins without proper verification.
• 📸 X-rays can verify tube placement, but are not used frequently in pediatrics due to radiation concerns. Alternative methods like pH testing are recommended.
• 🤧 Babies or children with respiratory infections may have their epiglottis open more often, increasing the risk of tube misplacement into the lungs.
• 🧑‍⚕️ Blowing in the child's face during insertion can trigger a startle reflex that encourages swallowing and aids the tube's correct placement.
• 📏 The tube’s correct length is measured by aligning it from the nose to the ear, then to the stomach area, and marking the tube at this point.
• 📊 pH testing of stomach contents helps verify that the tube is correctly positioned in the stomach; a pH of 5.5 or lower is a good indicator.
• 🤲 Positioning, swaddling, and using tools like pacifiers help secure and calm the child during tube insertion.
• 🔁 Aspiration or air flushing can help reposition the tube if fluid cannot be aspirated, and the process may need to be repeated to ensure proper placement.

Q & A

What is an NG tube and why is it used?

An NG (nasogastric) tube is a flexible tube that is inserted through the nose, down the throat, and into the stomach. It is used to deliver nutrition, medications, or fluids directly into the stomach, especially in pediatric patients who cannot take these orally.

How long can an NG tube stay in place?

An NG tube can stay in place for a month or longer, depending on the patient’s condition. However, some older children prefer to remove and reinsert it daily to attend school without the tube.

What is the most serious risk associated with NG tube placement?

The most serious risk is misplacement of the NG tube into the lungs, which can lead to severe complications such as bronchial perforation, pneumothorax, respiratory failure, or death, especially if feeding begins without proper tube tip verification.

What is the primary method used to verify NG tube placement without an X-ray?

The primary method used is pH testing of the gastric fluid aspirated from the tube. If the fluid has a pH of 5.5 or lower, it indicates that the tube tip is likely in the stomach.

What should be done if a baby is crying or breathing rapidly during NG tube insertion?

If a baby is crying or breathing rapidly, the epiglottis may be open, increasing the risk of the tube entering the trachea. In this case, the tube should be removed and the procedure paused to avoid misplacement.

How can caregivers assist with NG tube insertion at home?

Caregivers can help secure the tube once inserted, practice proper tape placement to prevent the tube from moving, and participate in verifying the tube's placement. They should also monitor for any signs of tube dislodgement.

What should be done if no gastric contents can be aspirated after NG tube insertion?

If no gastric contents can be aspirated, reposition the child on their left side for 10-15 minutes. If there is still no aspirate, and no signs of respiratory distress, the tube should be removed and reinserted.

How is the length of the NG tube measured before insertion?

To measure the length of the NG tube, place the tip of the tube at the nose, extend it to the earlobe, and then to the midpoint between the xiphoid process (lower end of the sternum) and the umbilicus. This will give the correct length needed to reach the stomach.

Why is pH testing considered more reliable than osculation for NG tube placement verification?

pH testing is considered more reliable because osculation (listening for air sounds in the stomach) is not always accurate. Gastric contents typically have a pH of 5.5 or lower, which provides a more evidence-based method to confirm the tube is in the stomach.

What should be done if the NG tube causes coughing or breathing difficulties during insertion?

If the child coughs, chokes, or has trouble breathing during insertion, it is a sign that the tube may have entered the trachea. The tube should be pulled back immediately, and the procedure should be paused until the child is calm.