Removing a nasogastric (NG) tube is a straightforward procedure, but it needs to be done correctly to avoid discomfort, aspiration, or damage to the tube. The process involves confirming a medical order, positioning the patient upright, capping the tube, and withdrawing it in one smooth motion. It is performed by trained healthcare professionals, not by patients themselves.
Before Removal: Confirming Readiness
NG tube removal requires a documented order from a treating medical officer. Before that order is given, the care team assesses whether the patient’s gut is functioning well enough to manage without the tube. If the tube was placed to drain stomach contents (such as after surgery), the provider may order a trial clamping period first. During this trial, the tube is clamped shut for a set number of hours while the team monitors for nausea, vomiting, or abdominal bloating. If the patient tolerates the trial without any of those symptoms, that signals readiness for removal.
For tubes used for feeding, the clinical team evaluates whether the patient can take nutrition by mouth or through another route. Either way, a gastrointestinal assessment, including checking for bowel sounds and asking whether the patient has passed gas, helps confirm the gut is active enough to proceed.
Equipment You Need
Removal requires far less equipment than insertion. Gather the following before starting:
- Non-sterile gloves and any other standard personal protective equipment
- A spigot or cap to seal the end of the tube before withdrawal
- An emesis bag and tissues for the patient’s comfort (gagging or watery eyes are common)
- Adhesive remover if the tube is secured with tape that’s difficult to peel
- A towel or disposable pad to catch any fluid that drips from the tube
Some facilities also have a 60-mL syringe on hand with about 30 mL of water to flush the tube beforehand, clearing any residual contents so they don’t drip into the throat during removal.
Step-by-Step Removal Process
Confirm the patient’s identity using at least three approved identifiers, verify the removal order, and explain the procedure so the patient knows what to expect. Then follow these steps:
1. Position the patient upright. Sit the patient up with their head supported on pillows. An upright position reduces the risk of any fluid draining back into the airway. For patients with spinal injuries or neurological conditions, follow the specific positioning instructions from their treating team instead.
2. Turn off any feeds or suction. Disconnect everything attached to the tube. Leaving a feeding pump running during removal creates an aspiration risk.
3. Flush the tube (if indicated). Draw up 30 mL of water in a syringe and push it through the tube to clear any remaining formula or gastric contents. This step prevents residual fluid from leaking into the throat as the tube comes out.
4. Cap or spigot the tube. Seal the open end with a cap or spigot. This stops any backflow of stomach contents during withdrawal.
5. Remove the securing device. Carefully peel off the tape or adhesive device holding the tube to the patient’s nose. Use adhesive remover if needed to avoid pulling on the skin.
6. Ask the patient to hold their breath. Taking and holding a breath closes the airway, which helps prevent any fluid from entering the lungs as the tube passes through the throat. Some clinicians ask the patient to exhale slowly instead. Either technique keeps the airway protected during the brief moment the tube crosses the back of the throat.
7. Withdraw the tube in one slow, continuous motion. Stand to the side of the patient and pull the tube out smoothly and steadily. Do not yank or use force. If you feel resistance at any point, stop immediately and seek medical advice, because the tube may have knotted inside the stomach or esophagus. Forcing a knotted tube can cause serious tissue damage.
8. Inspect the tube tip. Once the tube is out, check that the tip is intact. A missing or damaged tip means a piece may have broken off inside the patient, which requires urgent medical attention.
9. Dispose of equipment according to your facility’s infection control policy.
What the Patient Feels
Most patients describe the sensation as uncomfortable but not painful. There is often a pulling feeling in the back of the nose and throat, and gagging is common as the tube passes the back of the tongue. The entire withdrawal takes only a few seconds. Some people experience a sore throat or mild nasal irritation afterward, which typically resolves within a day or two.
After the Tube Is Out
Offer the patient oral hygiene right away. Having a tube in the nose and throat dries out the mouth and can leave an unpleasant taste, so a mouth rinse, toothbrush, or even a sip of water makes a noticeable difference in comfort.
Continue monitoring for signs that the gut isn’t handling things well on its own. Watch for nausea, vomiting, abdominal bloating or discomfort, and difficulty tolerating food or fluids. These symptoms could mean the tube needs to be reinserted. Document the removal, the reason for it, and the condition of the tube tip in the patient’s health record.
Vital signs should also be checked in the period following removal, and any changes in the patient’s condition should be escalated to the appropriate team member.
Aspiration Risk During and After Removal
One common concern is whether removing the tube increases the chance of aspiration, where fluid enters the lungs instead of the stomach. A study of 147 patients with swallowing difficulties found that aspiration severity scores were essentially the same whether the NG tube was in place or had just been removed. This held true regardless of the patient’s swallowing function, cognitive level, or overall functional status. In other words, the act of removing the tube does not create a new spike in aspiration risk. The upright positioning, tube capping, and breath-holding steps are precautions that keep the already-low risk manageable.
When Removal Gets Complicated
The vast majority of NG tube removals are uneventful, but a few situations require extra caution. If the tube won’t come out with gentle, steady traction, it may have formed a knot, particularly if it has been in place for a long time or if excess tubing was coiled in the stomach. Forcing it risks tearing the esophageal lining. In these cases, imaging (usually an X-ray) is needed to see what’s happening, and a specialist may need to intervene.
Patients who have recently had esophageal or upper gastrointestinal surgery should only have their NG tube removed under the direction of the surgical team, because the standard technique could disrupt healing tissue. Similarly, patients with certain neurological or spinal conditions need modified positioning during the procedure, which should be guided by their treating clinicians.