Why Flushing an NG Tube is Essential
A nasogastric (NG) tube is a medical device used for providing nutrients and medication directly to the stomach when a patient is unable to take them orally. To ensure the tube functions correctly and safely, regular flushing is necessary. The primary purpose of flushing is to prevent tube occlusion, which can be caused by thick formulas or medication residue. Proper flushing also helps to maintain patient hydration and clear the tube between different medications to prevent drug interactions.
Primary Solutions for Flushing an NG Tube
When considering what to use for flushing an NG tube, several solutions are recommended based on the patient's specific needs and the healthcare provider's instructions. The most common and widely accepted solutions are sterile or cooled, boiled water and, in certain clinical contexts, normal saline.
Sterile or Cooled, Boiled Water
For routine flushing and medication administration, sterile or boiled water is the standard. Home care instructions often specify using cooled, boiled tap water to ensure it is free of harmful microorganisms. Healthcare providers recommend a specific volume of water, often between 30-60 mL, to be used before and after each feed and medication. For continuous feeds, flushing is typically done every 4 hours or as directed.
Normal Saline Solution
Normal saline solution can also be used for flushing, particularly in a hospital setting where it is readily available and appropriate for managing fluid balance. While water is typically sufficient, saline may be specified in certain clinical protocols. For example, some facilities use saline during or after medication administration. It is important to always follow the specific instructions from the healthcare team regarding which solution to use.
Pancreatic Enzyme Solutions for Clogs
In the event of a severe blockage that cannot be cleared with warm water and gentle pressure, a pancreatic enzyme solution or a commercial declogging kit may be necessary. These solutions must only be used under a healthcare provider's prescription and direction, as they are not for routine flushing.
The Step-by-Step Flushing Procedure
Following the correct procedure is just as important as using the right solution. The following steps outline a general guideline for flushing an NG tube. Always consult a healthcare professional for specific instructions.
- Preparation: Gather the necessary supplies: a clean enteral syringe (usually 60 mL), the prescribed flushing solution (e.g., cooled, boiled water), and disposable gloves.
- Hand Hygiene: Wash your hands thoroughly with soap and water.
- Position the Patient: Ensure the patient is sitting in an upright or semi-upright position (at least 30-45 degrees) to prevent aspiration.
- Check Tube Placement: Verify the NG tube's position by checking the external markings. A misplaced tube should never be flushed.
- Draw the Solution: Draw the recommended volume of flushing solution into the syringe.
- Administer the Flush: Connect the syringe to the NG tube's port. Apply gentle, steady pressure to push the fluid into the tube. Do not use excessive force, as this can damage the tube or cause patient discomfort.
- Reconnect: After the flush, disconnect the syringe and recap the tube securely. If administering medication or feed, connect the next syringe or feeding bag.
Comparison of NG Tube Flushing Solutions
| Feature | Sterile or Boiled Water | Normal Saline Solution | Pancreatic Enzyme Solution |
|---|---|---|---|
| Purpose | Routine flushing to prevent clogs and maintain hydration. Used before/after feeds and meds. | Can be used for routine flushing, especially in clinical settings, or for specific medical reasons. | Used for clearing stubborn, established blockages that water cannot resolve. |
| Availability | Easily accessible at home (after boiling and cooling). | Standard in hospital and clinical settings. Often requires a prescription for home use. | Requires a prescription and should be administered by a trained professional. |
| Cost | Minimal. | Higher than water, but relatively inexpensive in clinical settings. | Higher, as it is a specialized product for medical use. |
| Best Practice | Most recommended for everyday use. Preferred for most medication administration. | Used according to institutional protocol or for specific patient needs. | Use only as a last resort for clearing clogs, never for routine flushing. |
What to Avoid When Flushing an NG Tube
Just as important as knowing what you can use is knowing what you should never put down an NG tube. Some substances can worsen blockages or damage the tube itself.
- Acidic Juices or Carbonated Beverages: While some older practices suggested using sodas, modern research shows that acidic beverages can cause proteins in the enteral formula to precipitate, leading to harder, more stubborn clogs. Never flush with cranberry juice, soda, or other similar drinks.
- Crushed Medications without Dilution: Pills that are not properly crushed to a fine powder and dissolved completely can block the tube. Enteric-coated, extended-release, or sublingual medications should never be crushed and administered via the tube.
- Excessive Force: Never force the syringe plunger if you encounter resistance. This can cause the tube to rupture or become dislodged. If flushing is difficult, try repositioning the patient or gently pulling back and pushing forward the plunger in a "push-pull" motion before escalating.
Conclusion
Proper and consistent flushing is crucial for anyone using an NG tube for nutrition or medication. The most common and recommended solution is sterile or cooled, boiled water, used before and after every feed and medication administration to prevent blockages. Normal saline is also an acceptable option under professional guidance. For severe clogs, specialized enzyme solutions may be required, but only with a healthcare provider's direction. By following proper flushing techniques and avoiding unsuitable substances, caregivers and patients can ensure the NG tube remains functional, safe, and effective for delivering essential nutrition.
