A nasoenteric tube (NET) is a flexible, narrow tube inserted through a person’s nostril, passing down the throat and esophagus, and ending in the stomach or the small intestine. This temporary medical device is primarily used to provide nutrition, fluids, and medications directly into the gastrointestinal tract when a patient cannot safely consume food orally. Using a NET helps maintain or improve nutritional status and hydration levels while ensuring the digestive system remains active and functional.
Primary Indications for Nasoenteric Feeding
The necessity for a NET often arises from conditions that compromise the safety or adequacy of oral intake. Primary uses include nutritional support for individuals with impaired swallowing (dysphagia), often following a stroke or due to neurological disorders. Patients with a lowered level of consciousness or severe malnutrition also require this method for supplementary calories.
NETs are also utilized for gastric decompression, which involves suctioning out stomach contents. This is commonly done in cases of bowel obstruction, gastric outlet obstruction, or post-surgery to relieve pressure and prevent vomiting. The tube can also serve as a direct channel for administering specific liquid medications.
Insertion Methods and Verification
The process of placing a nasoenteric tube is typically performed at the bedside without surgery. Healthcare providers first measure the required length, often using the nose-to-earlobe-to-xiphoid (NEX) process. After lubricating the tube tip, it is gently advanced through the nostril. The patient is often asked to sip water during the procedure to encourage swallowing, helping the tube pass smoothly down the esophagus.
The tube’s final position dictates its name and function: a nasogastric (NG) tube terminates in the stomach, while a post-pyloric tube extends into the small intestine (nasoduodenal or nasojejunal). Correct placement must be verified before the tube is used, as misplacement into the airway can lead to severe respiratory complications.
The gold standard for initial confirmation is a chest X-ray, which visually tracks the radio-opaque line embedded in the tube to confirm correct tip positioning. A secondary verification method involves aspirating fluid and testing its acidity with pH paper; gastric aspirate typically has a pH of 5.5 or lower, indicating the tube is likely in the stomach. Measuring and marking the external length of the tube at the nostril is an ongoing check to detect migration. Relying solely on non-recommended methods, like injecting air and listening over the abdomen, is unreliable and can endanger the patient.
Essential Daily Care and Maintenance
Routine maintenance of a nasoenteric tube is essential for preventing complications. The primary daily task is flushing the tube with water to maintain patency and prevent blockages from formula or medication residue. Flushing should occur before and after every use, including before and after medication administration, and at least every four to eight hours during continuous feeding.
The technique involves using a large syringe, typically 30 to 60 milliliters, to gently push the prescribed amount of water through the tube. Using smaller syringes can create excessive pressure, potentially damaging the tube.
Medication Administration
Medication administration requires special attention. Liquid forms are preferred, and crushed pills must be finely pulverized and mixed thoroughly with warm water to prevent clogging. Each medication should be administered separately, with a water flush performed between each one.
Skin Care and Positioning
Proper care of the skin around the nostril is required to prevent irritation and pressure injury. The securement device or tape should be changed daily, and the skin cleaned using warm water and mild soap to remove secretions or crusting. When retaping, check the external measurement marking to ensure the tube has not shifted. During feeding, the head of the bed must be elevated to at least a 30 to 45-degree angle and remain elevated for 30 to 60 minutes afterward to reduce the risk of aspiration.
Identifying and Managing Complications
Prompt identification and management are required for complications arising from NET use. Tube clogging is a frequent issue, signaled by resistance during flushing or feeding. If a clog occurs, gentle attempts to flush the tube with warm water using a large syringe may clear the blockage. If this fails, specialized declogging solutions may be used under a healthcare provider’s direction.
Tube displacement or migration is common, especially in patients who cough frequently or gag. A change in the external measurement or new symptoms like coughing or respiratory distress suggest the tube has moved. It should not be used until placement is re-verified, ideally with an X-ray.
The most severe complication is pulmonary aspiration, where feeding formula or gastric contents enter the lungs. Signs include sudden coughing, difficulty breathing, or changes in skin color, requiring immediate cessation of feeding and medical attention. Other complications involve the insertion site, such as skin irritation, nasal septum erosion, or pressure injury. Redness, swelling, or drainage around the nostril should be reported promptly to prevent infection or worsening tissue damage.