Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.

HINT: Why is activating the internal lubricant in nasogastric tubes important?

SITUATION:

This QuickHit was informed by a hospital practice reminder highlighting the importance of activating the internal lubricant of the Nasogastric Tube (NG) tube prior to guidewire removal following an increase in safety reports related to broken or leaking NG tubes.

BACKGROUND:

Many children with medical complexity rely on enteral feeding tubes to support nutrition, hydration, and/or medication administration in home and community. NG tubes are a common type of enteral tube and a frequently used brand in home and community is the Avanos™ CORFLO™ NG tube. This NG tube has a guidewire (sometimes referred to as a stylet) that allows for easier insertion and is removed prior to using the tube.

Increased incidences of broken, kinked or leaking NG tubes have highlighted the importance of activating the internal lubricant of the NG tube prior to guidewire removal. When the internal lubricant is not activated, it increases the risk of micro-tears or kinking during guidewire removal. This can result in an increased need for troubleshooting, patient discomfort, and/or reinsertion of the NG tube.

ASSESSMENT:

The Avanos™ CORFLO™ NG tube is made of a flexible polyurethane material and is replaced every 4 weeks. The child's healthcare team will develop a plan for NG tube insertions and replacements (e.g., in a clinic or at home).

The NG tube consists of the following parts:

Guidewire: A thin metal wire threaded inside the full length of the NG tube during insertion to provide rigidity and aid insertion.
ENFit Connector (Main port and side port): The location where syringes or feeding sets attach to the NG tube.
Exit Port: Hole at end of the NG tube where nutrition, medications or fluids enter the stomach.
Weighted Tip: The end of the tube (past the exit port) that is heavier than the rest of the tube for the purpose of anchoring the tube inside the child’s stomach. Not all children will have a NG tube with a weighted tip.

RECOMMENDATION:

Connected Care recommends the following best practice when inserting Avanos™ CORFLO™ NG feeding tubes:

Confirm the type, size, indication, and replacement frequency of the NG tube in the child’s care plan.
Measure the appropriate insertion depth of the NG tube as outlined in the AboutKidsHealth How to Insert Your Child's NG Tube article. Prior to inserting the NG tube, ensure the guidewire is easy to remove, then secure it to the main port.
Once the NG tube is inserted to the measured depth:
- Loosely secure the tube to the child’s face without kinking it.
- Confirm placement of the tube using pH as outlined in this QuickHit.
- Activate the tube’s internal lubricant by flushing the side port with up to 10mL of water. Consider using smaller volumes of water for children who are fluid restricted (minimum 2mL).
- Cap side port and gently remove guidewire from main port.
- Resecure the tape to the child’s face, ensuring that the tape does not cover their nostril

If the NG tube is accidentally pulled out before it is due to be changed, you may reinsert the same tube after inspecting it for any damage and rethreading the guidewire into the NG tube prior to reinsertion.

The internal lubricant cannot be re-activated with a subsequent insertion of the same NG tube. Therefore, gently remove the guidewire and inspect for any cracks during subsequent reinsertions or insert a new NG tube.
If the same NG tube dislodges again, consider inserting a new NG tube.

To learn more about NG tubes, visit the following AboutKidsHealth articles on NG Tubes: How to insert your child's NG tube, Feeding your child and Common problems

Have a Question? Initiate a Consult!