Nasogastric and NasoEnteric Tube Placement

What is an enteral tube?
An enteral tube is a tube that is placed through the nose and into the stomach or the small bowel to decompress the stomach, or to assist with feeding and to provide nutrition. There are three types of enteral tubes: nasogastric, nasoduodenal, and nasojejunal, depending on where the tube ends: in the stomach, the duodenum, or the jejunum.

Why is it ordered?
An enteral tube is placed for the patient who is unable to take in enough food or drink through the mouth to maintain body weight. Nasogastric (NG) tubes are usually placed for a short period of time. They can be used to remove gastric secretions, prevent abdominal bloating and vomiting, and to provide a way for feedings and medication administration.

A nasoduodenal (ND) or nasojejunal (NJ) tube may be placed for those who have trouble digesting food or who aspirate food or drink into the lungs. They are also used for patients with pancreatic diseases who need to be fed into the small bowel directly. ND and NJ tubes may not be used for all medicines and may require a pump for feedings.

What should my health care professional know before I have this procedure done?

• If you have allergies to:
  • Any medications, specifically any sedatives (sleeping medicines)
  • Any numbing medication (ex: lidocaine, benzocaine)
  • Contrast dye or iodine (If you have an allergy, your doctor may have you take a steroid 24 hours before the procedure or use barium instead of contrast dye or iodine)
  • Latex
• If you have any blood clotting or bleeding problems or if you’re taking aspirin, ibuprofen, or any blood thinners (such as heparin, warfarin (Coumadin®), clopidogrel (Plavix®), aspirin-dipyridamole capsules (Aggrenox®), or enoxaparin (Lovenox®). If you are unsure about your medications, please ask your doctor.

Do I need anything to get ready for the procedure?

• If you are on blood thinners, check with your physician about discontinuing them before the procedure.
• You should have current blood work (blood clotting studies and a blood platelet count).
• You cannot eat or drink anything after midnight the night before the procedure if you are having sedation. Ask your doctor if you have questions about whether you may eat or drink.

Where is this done?
Most NG tubes are placed at the bedside.

Nasoduodenal and nasojejunal tubes may be placed in the:

• GI Endoscopy department at Duke University Hospital, zero level.
• GI Radiology Department at Duke University Hospital.
• Bedside, occasionally

What is involved in placing an enteral tube?
A nasogastric tube or an NG tube is placed through the nose and into the stomach. Most are placed at the bedside by a nurse, doctor, or another health care provider. You will be in a sitting position during placement. Sedation is not usually given. The end of the tube will be lubricated to ease insertion.

You will be asked to extend and flex your neck and to swallow to help with passage of the tube. It will be a little uncomfortable at first, but only for a few minutes while the tube is being passed. The tube will be checked to make sure it is in the right place then the tube will be taped in placed. The NG tube can be used immediately after placement is confirmed.

Nasodoudenal (ND) or nasojejunal(NJ) tubes are other types of enteral tubes. Sometimes these tubes are called Dubhoff®, Corpak® or Entriflex® tubes. The procedure varies, depending on where the tube is inserted. Your tube will be inserted in:

• GI Radiology: In GI Radiology, feeding tubes are inserted with the help of x-rays. The nose and throat is numbed with viscous lidocaine. The tube is placed through the nose to the stomach and then into the small bowel. At this point, contrast dye may be put in through the tube to help the doctor see where the tube is located in the bowel.  An x-ray will be done to make sure the tube is in the right place. The whole procedure lasts about 45 minutes to one hour. The actual tube insertion lasts less than 15 minutes.

• GI Endoscopy: In GI Endoscopy, ND and NJ tubes are inserted endoscopically (a tube with a little light and camera on the end is inserted into the esophagus and into the small intestine). After your medical history is assessed, an IV is inserted. Blood work is reviewed to make sure your clotting values are normal. Your blood pressure, heart rate, and oxygen saturation are monitored. You will receive oxygen throughout the procedure. Your throat will be numbed to stop the gag reflex. You will be given medicine to make you sleepy. The procedure lasts about 45 minutes to one hour.
  

Is the procedure painful?
During insertion of the NG tube, you may have some mild discomfort and bloating. The tube may be a little irritating to your throat at first, but usually goes away quickly.

When nasoduodenal and nasojejunal tube are inserted using endoscopy, you will be given medication throughout the procedure, so you should be very comfortable. When nasoduodenal and nasojejunal tubes are inserted with endoscopy, numbing medicine is used in the nose to reduce discomfort.

What are the risks of the procedure?

• An allergic reaction to the medication or contrast dye
• Bleeding
• A tiny hole or perforation in the esophagus, stomach, or small intestine
• Misplacing the tube into your lungs
• Infection or fever

What happens after the procedure?
The tube will be taped at the nose. If inserted for decompression rather than feeding, it may be attached to a low suction. If you were given sedation, you will be in the recovery room for at least 30 minutes.

• If you are staying in the hospital, the nurse will give report to the nurse taking care of you on the floor. Once recovered, you will be discharged to your room. A dietitian or floor nurse will discuss with you how to use your tube for feeding, how to take care of it at home, and what feeding solution is the best for you at that time.
• If you are going home, your driver can come and sit with you in the recovery area. Discharge instructions will be given. Your IV will be taken out and the doctor will come and talk to you before you leave.
• The doctor who ordered your tube placement will make arrangements for your follow-up. This may involve teaching in the clinic or a visit from a home health nurse. This should be done within one day from the tube insertion. While you are waiting for these instructions, flush with 20 cc of tap water about every three hours until the clinic or home health nurse gives you further instructions. Make sure you have a syringe and “Bolus or Syringe Feeding” Instructions before you go home. Call your doctor if you have questions.

Do I need someone to drive me home afterward?
If you are not staying in the hospital and have gotten sedation, then yes. If you are given sedation, you can not drive for 24 hours after the procedure.

When do I need to call the doctor?
Your tube should be ready to use once placement has been confirmed. If you have a problem with your tube, refer to the chart below.

 This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.