How To Select The Appropriate Nasogastric Tube

Nasogastric tubes (NGTs) are essential medical devices used in a wide range of clinical settings for enteral feeding and gastric drainage. Whether you are a healthcare provider selecting an NGT for a patient or a medical professional looking to deepen your understanding of these devices, choosing the right nasogastric tube is critical to patient safety, comfort, and treatment success.

In this article, we’ll explore the key factors to consider when selecting the most appropriate nasogastric tube, covering everything from tube type and material to diameter and connector safety. By the end, you’ll be better equipped to make informed decisions based on patient needs and clinical requirements.

Determine the Intended Use: Feeding, Drainage, or Both?

The first step in selecting an NGT is determining its primary purpose: enteral feeding, gastric drainage, or a combination of both. Understanding the intended use is critical because it directly impacts the type of tube, its lumen configuration, and the connectors required.

• Feeding Tubes: These typically have a single lumen and are equipped with ENFit connectors to ensure safe delivery of enteral nutrition. ENFit connectors are specifically designed to minimise the risk of dangerous misconnections with other medical systems, such as intravenous (IV) lines.
• Drainage Tubes: For gastric drainage, NGTs may feature single or double lumens and usually have funnel connectors. Drainage assists in the removal of stomach contents to relieve symptoms and provide samples for diagnostic purposes.
• Combination Tubes: If the NGT is intended for both feeding and drainage, you might require a multi-lumen tube that offers compatibility with both ENFit and funnel connectors.

Understanding whether you’re dealing with a ryles tube, a levin tube, or a standard nasogastric tube will help determine the best device for the clinical scenario. A ryles tube vs nasogastric tube comparison reveals that ryles tubes are generally thicker, making them more suitable for short-term drainage, while Levin tubes are thinner and are commonly used for longer-term feeding. Pennine Healthcare one of the UK’s leading suppliers of ryles and levin tubes making us the perfect partner for your practice.

Choose the Right Tube Material

The material of the NGT plays a significant role in patient comfort and the duration of use. The three most common materials are PVC, silicone, and polyurethane, each offering different benefits and limitations:

• PVC (Polyvinyl Chloride): Ideal for short-term use, typically less than 7 days, PVC tubes are cost-effective but more rigid. While their stiffness helps prevent clogging, it can also make them less comfortable for patients. PVC is a common choice for gastric drainage tubes.
• Silicone: More flexible and biocompatible than PVC, silicone tubes are well-suited for medium-term use, lasting up to 6 weeks. Their softness enhances patient comfort, although they are more prone to kinking during insertion, often necessitating the use of a stylet to ease placement.
• Polyurethane: Offering a balance between rigidity and comfort, polyurethane tubes are often used for longer-term feeding (up to 6 weeks). These tubes soften when warmed by body temperature, making them comfortable for patients, while still maintaining durability. They also offer thinner walls, allowing a larger lumen without increasing the external diameter.

Choosing the right material ensures not only patient comfort but also long-term treatment success. For example, a ryles tube, often made of PVC, may be less suitable for long-term feeding due to its rigidity, while a Levin tube made from polyurethane or silicone is often more comfortable for longer-term use.

Select the Appropriate Diameter

The diameter of the nasogastric tube, measured in French gauge (Fr), affects both patient comfort and clinical performance. Selecting the correct size is crucial:

• Smaller Bore Tubes (<12 Fr): Typically used for feeding, these tubes improve patient comfort and reduce complications such as nasal irritation, oesophageal reflux, and tube blockage.
• Larger Bore Tubes (>12 Fr): Used mainly for drainage, larger bore tubes are more suitable for removing gastric contents, as their increased diameter reduces the risk of clogging.

Neonatal tubes start as small as 3.5 Fr, while adult tubes may range up to 24 Fr, depending on whether the tube is being used for feeding or drainage. In practice, tubes between 8 Fr and 12 Fr are often chosen for feeding, while larger tubes are selected for drainage or dual-purpose needs.

Consider Tube Length and Placement Site

NGTs come in varying lengths, typically ranging from 90 to 165 cm for adults. The correct length is determined by the placement site, whether it is for gastric or jejunal feeding:

• Gastric Tubes: Generally, between 90 and 120 cm, these tubes are placed directly into the stomach. Gastric feeding is the most common choice for patients who can digest food normally.
• Jejunal Tubes: Longer tubes, typically 120 to 165 cm, are used for patients requiring feeding directly into the small intestine. This is often the case for patients with specific medical conditions such as gastric outlet obstruction or gastroparesis.

Choosing the right tube length ensures proper placement and functionality, whether for short-term gastric drainage or long-term jejunal feeding.

Evaluate Connector Types and Safety Features

Safety is a paramount concern when selecting an NGT, especially when it comes to preventing dangerous misconnections with other medical devices. Here’s what to consider:

• ENFit Connectors: Designed to enhance patient safety, ENFit connectors are standard for enteral feeding tubes. They are incompatible with IV systems, reducing the risk of life-threatening misconnections.
• Funnel Connectors: These are typically used for drainage tubes, allowing for easy removal of gastric contents. While funnel connectors may be compatible with older ENLock systems, it is important to ensure that they meet your facility’s current standards for safety and functionality.

The right connector ensures both compatibility with existing medical devices and adherence to safety protocols, reducing the risk of misconnection. Pennine Healthcare can supply ENFit connectors to your practice, get in touch with us today and speak to an expert.

Make an Informed Choice for Your Patients

Selecting the appropriate nasogastric tube is a crucial decision that impacts patient outcomes, comfort, and safety. By understanding the tube’s intended use, material, diameter, length, and connector type, healthcare professionals can make informed decisions that align with both clinical needs and patient well-being.

Are you looking for more detailed information on nasogastric tubes, feeding systems, or safety protocols? Download your FREE copy of Pennine Healthcare’s Gastroenterology Brochure to explore our full range of NGT products and discover how we prioritise patient safety and care at every step.