Overview

Pediatric NG Tube Insertion is a procedure used to place a tube through the nose into the stomach for feeding, medication administration, or gastric decompression. This procedure requires specific techniques adapted for pediatric anatomy.

NG tubes are essential for providing nutrition, administering medications, and decompressing the stomach in pediatric patients who cannot eat orally. Proper technique is crucial to avoid complications and ensure correct placement.

Indications

Enteral Feeding

Nutritional support when oral feeding inadequate

Medication Administration

Oral medications when patient cannot swallow

Gastric Decompression

Relief of gastric distention and vomiting

Gastric Lavage

Poisoning or overdose management

Diagnostic Testing

Gastric pH monitoring, gastric aspirate analysis

Contraindications

Absolute Contraindications

Severe facial trauma
Basilar skull fracture
Esophageal obstruction
Patient or family refusal

Relative Contraindications

Coagulopathy
Recent nasal surgery
Severe epistaxis
Limited experience with procedure

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes explaining the procedure to patient and family, selecting appropriate tube size, gathering necessary equipment, ensuring proper patient positioning, and preparing for potential complications. All team members should understand their roles.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure to patient and family using age-appropriate language. Position patient in semi-Fowler position. Measure tube length from nose to ear to xiphoid.

⚠️ Common Mistakes to Avoid:

  • Inadequate explanation
  • Poor positioning
  • Incorrect tube measurement

💡 Pro Tip:

Use age-appropriate language and involve parents in the process.

Step 2: Tube Selection

Select appropriate tube size based on patient age and indication. Mark tube at measured length. Lubricate tube tip.

⚠️ Common Mistakes to Avoid:

  • Wrong tube size
  • Inadequate lubrication
  • Poor marking

💡 Pro Tip:

Use age-based formulas for tube size: (age/2) + 12 for feeding tubes.

Step 3: Nostril Selection

Choose patent nostril. Clean nostril with saline. Apply lubricant to nostril and tube tip.

⚠️ Common Mistakes to Avoid:

  • Choosing blocked nostril
  • Insufficient lubrication
  • Poor cleaning

💡 Pro Tip:

Test both nostrils for patency before insertion.

Step 4: Tube Insertion

Insert tube along floor of nasal cavity. Advance tube to marked length. Encourage patient to swallow if cooperative.

⚠️ Common Mistakes to Avoid:

  • Wrong insertion angle
  • Inadequate advancement
  • Poor patient cooperation

💡 Pro Tip:

Insert along the floor of the nasal cavity to avoid turbinates.

Step 5: Placement Confirmation

Confirm placement with multiple methods: aspiration of gastric contents, auscultation of air insufflation, chest X-ray if needed.

⚠️ Common Mistakes to Avoid:

  • Relying on single method
  • Poor auscultation technique
  • Inadequate confirmation

💡 Pro Tip:

Always use multiple methods to confirm proper placement.

Step 6: Securing and Documentation

Secure tube with tape or commercial device. Document insertion details. Monitor for complications.

⚠️ Common Mistakes to Avoid:

  • Poor securing technique
  • Inadequate documentation
  • Poor monitoring

💡 Pro Tip:

Secure the tube properly to prevent dislodgement.

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Post-procedure Care

Post-insertion care involves confirming proper placement, securing the tube, monitoring for complications, and documenting the procedure. Regular assessment of tube position and function is essential.

Complications & Management

Complication Incidence Signs Management Prevention
Misplacement 5-10% Cough, respiratory distress, poor feeding Remove tube, reinsert with confirmation Proper technique, confirmation
Nasal trauma 10-20% Epistaxis, nasal pain, ulceration Remove tube, nasal care Proper technique, lubrication
Sinusitis 5-15% Facial pain, purulent discharge Remove tube, antibiotics if needed Proper technique, regular care
Tube dislodgement 10-25% Tube visible in mouth, poor feeding Remove tube, reinsert if needed Proper securing, monitoring

Clinical Pearls

💡

Use age-appropriate language and involve parents in the process.

🎯

Use age-based formulas for tube size: (age/2) + 12 for feeding tubes.

Test both nostrils for patency before insertion.

🔍

Insert along the floor of the nasal cavity to avoid turbinates.

📊

Always use multiple methods to confirm proper placement.

🎨

Secure the tube properly to prevent dislodgement.

⚠️

Measure tube length from nose to ear to xiphoid process.