Securing a nasogastric (NG) tube properly is the single most important step in preventing it from slipping out of position. Tubes held in place with standard tape alone have displacement rates as high as 62%, so technique and material choices matter enormously. The core principle is straightforward: anchor the tube firmly to the nose or face while allowing enough flexibility that swallowing and head movement don’t pull it loose or press it into the skin.
Preparing the Skin Before Taping
Adhesive tape sticks poorly to oily skin, and the nose produces a steady supply of sebum that weakens the bond over time. Before applying any tape, clean the skin on and around the nose with an alcohol wipe or mild soap and water, then let it dry completely. For patients who will have the tube for more than a day or two, a skin barrier wipe creates a thin protective film that serves two purposes: it improves tape adhesion and reduces irritation from repeated tape changes. Adhesive remover wipes are equally useful on the other end of the process, allowing you to peel tape off without stripping fragile skin.
The Hinge Taping Method
One well-documented approach, published in the Annals of The Royal College of Surgeons of England, uses a simple “hinge” that keeps the tube secure while still letting it move slightly during swallowing. Here’s how it works:
- Step 1: Cut a 10 cm strip of adhesive tape (Elastoplast or Mefix work well) and press one end firmly along the length of the nose.
- Step 2: Pinch the free end of the tape together beyond the tip of the nose so it forms a narrow tape-to-tape bridge, or hinge.
- Step 3: Wrap the remaining free end tightly around the NG tube itself.
- Step 4: Place a shorter strip of tape (about 5 cm) horizontally across the bridge of the nose over the first piece. This cross-piece locks the whole system in place.
The hinge is the key detail. Because the tube isn’t taped rigidly flush against the nostril, it can shift slightly when the patient swallows or turns their head. That small amount of movement dramatically reduces the risk of pressure necrosis, the tissue damage that develops when a stiff tube presses into the rim of the nostril for hours or days. Replace the tape every two to three days, since skin oils gradually loosen the adhesive.
Alternative Taping Styles
The “butterfly” method is another common option. You split one end of a strip of tape lengthwise, press the unsplit portion across the bridge of the nose, then wrap each of the two tails in opposite directions around the tube just below the nostril. This creates a secure anchor with two independent contact points on the tube, so even if one tail loosens the other still holds.
Some facilities use a “mushroom” shaped adhesive configuration (sometimes sold as a pre-cut commercial product) that adheres broadly across the nose and narrows to a tab around the tube. The wider contact area distributes pulling forces more evenly. Semipermeable transparent dressings are another alternative. They stick well, allow the skin to breathe, and let you visually inspect the nostril without removing the tape.
Nasal Bridles for High-Risk Patients
For patients who repeatedly pull at their tubes, are heavily sedated and moving unpredictably, or are in the ICU, tape alone often isn’t enough. A nasal bridle is a thin, flexible clip or ribbon that loops around the nasal septum (the cartilage between the nostrils) and attaches to the tube. It anchors the tube to a structure far sturdier than skin.
The numbers are striking. A meta-analysis found that tubes secured with tape alone were dislodged 40% of the time, compared to just 14% with a nasal bridle. The odds of dislodgement dropped by roughly 84% when a bridle was used. Bridled patients also received a higher percentage of their daily calorie goals, simply because their feeding tubes stayed in place long enough to deliver the nutrition.
Bridles aren’t without trade-offs. Some studies report slightly higher rates of minor nosebleeds and, in rare cases, external nasal ulceration compared to tape. These findings are somewhat murky because older bridle techniques (manually looping suture material) carry different risks than modern commercial bridle devices. Still, for patients at high risk of pulling out their tube, the benefits consistently outweigh the downsides. One cost-effectiveness analysis found that routine bridling actually saved money overall by reducing the need for repeated tube replacements and X-ray confirmations.
Preventing Pressure Injuries at the Nostril
The point where the tube enters the nose is the most vulnerable spot for skin breakdown. A rigid tube pressing against the rim of the nostril creates constant friction and pressure, and within a day or two this can progress to redness, ulceration, or full-thickness tissue damage.
Several strategies reduce this risk. Padding the tube with a small piece of thin foam dressing (such as Mepilex Lite) right where it contacts the nostril cushions the pressure point. Placing a hydrocolloid dressing on the skin of the nose before taping over it adds another protective layer between the adhesive and the skin. The hinge taping technique described above also helps by preventing the tube from sitting in a fixed position against the tissue.
If the tube needs to sit in the other nostril instead, alternating sides during a tube change gives the original nostril time to recover. In some ICU setups, the NG tube can be clipped to an endotracheal tube using a connector device, which shifts the anchoring force away from the nose entirely, though this only works when both tubes are present.
Checking and Maintaining Tube Position
A well-secured tube can still migrate if the tape loosens or the patient moves enough over time. Clinical guidelines recommend checking tube position every four hours and before giving any feeding or medication through it. The simplest check is measuring the visible length of tube outside the nose and comparing it to the length that was recorded when placement was confirmed by X-ray. Many tubes have centimeter markings printed on them for exactly this purpose.
At the start of every nursing shift, verify that the external marking at the nostril hasn’t changed. Assess the skin around the insertion site daily for redness, swelling, or breakdown. If the tape is peeling or the tube feels loose, re-secure it promptly rather than waiting for the next scheduled tape change. For patients with oily skin or those who are sweating heavily, you may need to change the tape more frequently than the standard two-to-three-day interval.
Securing NG Tubes in Infants and Children
Pediatric and neonatal skin is thinner, more fragile, and more prone to adhesive-related injury than adult skin. Use hypoallergenic tape or a gentle securement device approved for pediatric use. Avoid pulling tape off forcefully; adhesive remover wipes designed for sensitive skin make this safer. The tube size itself matters too. Neonates require the smallest available tubes to avoid injuring their narrow nasal passages and delicate gastrointestinal lining.
The same principles of pressure prevention apply, just with greater urgency. Check the nostril and surrounding skin frequently, use the least aggressive adhesive that still holds reliably, and ensure the tube has a small amount of play so it doesn’t press rigidly into tissue. In pediatric populations, commercial nasal bridles have also shown significant reductions in tube displacement without added complications, making them a reasonable option for children who are at high risk of pulling their tubes.