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Nasogastric Feeding Passport for Patient

Patients name:

This passport has been designed to provide you with helpful information regarding your nasogastric feeding tube for you to refer to once you are home.

Please keep this document safe as it contains a record that you have been observed and confirmed safe to use the tube yourself at home without a nurse present.

What is a nasogastric feeding tube?

A nasogastric tube (NGT) is a long, thin, hollow tube which is passed through the nostril, into the throat and down into the stomach. By having the tube in place, feeds, fluids and medications can bypass the mouth and pass into the stomach.

Please remember the tube can potentially enter the lungs and therefore it is extremely important to use the tube with care and ALWAYS check the pH BEFORE using the tube.

The pH MUST be 5.5 or below.

If the tube starts to come out of the nostril DO NOT push back down and re use. Contact your named Community Children’s Nurse (CNN) for a replacement.

What items are needed for the tube?

These items include pH strips and purple enteral feeding syringes. These will be provided by Fresenius Kabi. You will have a personalised order that will be set up prior to discharge home and these will be delivered every month.

You may also have a pump and giving sets if feeds are provided by a pump. If you have issues with your pump please contact Fresenius Kabi.

These also include a protective gel dressing called Comfeel/Duoderm, and tape to secure the tube in place called Tegaderm or Hypafix. These will be set up with the GP by your named CCN.

Your CCN will bring a nasogastric tube for any required changes.

Emergency box: It is recommended to create a box of emergency supplies to travel with you such as in a plastic container. This should contain a 20ml syringe, pH strips and spare dressings.

Referral to the CCN team

Nasogastric tube feeding will be commenced in hospital.

All training for use of the nasogastric tube will be provided by the nursing staff on Kingfisher Ward.

Once completed you will be referred to the CCN team who will support you with the tube once you are discharged home.

The CCN team pride themselves on keeping care in the community where possible. However, please be prepared to come to the Kingfisher Ward depending on team capacity if the tube requires changing/re inserting

Helpful information for once you are home

Cannot obtain a sample of stomach acid from the tube? (aspirate)

It is ONLY safe to use the tube if you can get an aspirate AND it is testing between 1 and 5.5 pH.

Tips to get an aspirate:

Change your child’s position and try to aspirate again – start with rolling onto their left side
Inject 1-5ml of air into the tube to remove a blockage at the end of the line or to move it from the stomach lining and re-aspirate
Wait 15-30 minutes and aspirate again
Give mouth cares if your child is nil by mouth (as this stimulates gastric secretions of acid) or if your child is allowed to have small amounts by mouth give them a little to eat.

NEVER flush with water if position is not confirmed

NEVER feed on the basis of aspirate appearance alone NEVER force a blocked tube – if it is blocked, tube will need replacing.

When should an aspirate be obtained?

It is important to always ensure the tube is in the correct position.

The tube should be aspirated and tested:

After each tube insertion
At least every 24hours
Before giving a feed or flush
Before giving medication
After any retching, vomiting or severe coughing episode which could dislodge it
If the tube has been pulled/caught
If measurement at nose has changed from the measurement when first inserted.

When will the tube be changed?

The tube can routinely stay in place for 90 days (Medicina enfit)

Your named CCN will book this in routinely to change.

DO NOT change the tube yourself until you have been trained by the CCN team.

If you are having issues with the tube, or the numbers on the tube rub off, the tube should be changed. Call your CCN to organise this.

When should the tube be flushed?
So long as your child is not fluid restricted (you will be told if this is the case) the NGT should be flushed pre and post feeds and between medications.

Your dietitian will advise you on the volume of water you should be using. What you use to flush depends on your child’s age:

Under six months or immunosuppressed: Use cooled boiled water
Over six months: Freshly drawn tap water

Use reusable syringes unless your dietitian, CCN or doctor recommend single use syringes.

Reusable syringes can be washed with warm soapy water and allowed to air dry. Do not re-use syringes after seven days or once the numbers have rubbed off.

Parent / carer competency assessment for use of the nasogastric tube

Date:

Competence practiced	Parent/carer signature	Trainer’s signature
Basic knowledge and information
1.1 Carer understands reason for infant/child requiring enteral feeds/medications via NGT
1.2 Basic anatomy and physiology of gastro-intestinal tract
1.3 Knowledge of when and where to access help if required
Equipment and preparation
Demonstrate good hand hygiene
Able to identify equipment required
Able to prepare child for pH testing and administration of feeds.
Able to aspirate the NGT appropriately and are aware of the correct pH which is safe for administration of feeds or medications.
Administration of feeds and medications
Prepare a clean environment for feeds.
Be aware of the correct storage for feed.
Check the look of feed, expiry date, temperature and that it corresponds to feeding plan.
Be aware of and demonstrate correct positioning of child during and after feed.
Demonstrate a safe bolus feeding technique or demonstrate correct use of pump – certificate from on-line training seen
Clean the equipment appropriately and be aware of how to dry and store.
Be aware of the importance of and provide the child with oral hygiene.
Complications
Know what to do if the tube if the tube falls out.
Know what to do if the tube appears blocked.
Know what to do if you are unable to obtain an aspirate or one that is reading above 5.5.

Sign-offs demonstrating competence in nasogastric tube use

Minimum of three sign offs. More to be competed as required for competency demonstration.

		Date	Assessor sign and print	Parent sign and print
ESSENTIAL	1
	2
	3
IF REQUIRED	4
	5
	6
	7
	8
	9
	10

Discharge checklist for nursing staff

Nurse to check and complete prior to discharge	Tick when completed or NA when not applicable
Has the parent/carer completed the NGT competencies and feel confident in using the NGT at home for feeding?
Has the parent been shown how to complete a tape change and have tapes to take home with them? Have more been ordered?
Has the child been seen by the dietitian and is their feed plan up to date?
Has a referral been made to the Home Enteral Nutrition Team (HEN) for set up with Fresenius Kabi?
Have the parents/carers had pump training if needed?
Does the family have a feed pump to take home and spare consumables? (At least 10 days’ supply or pre- made discharge pack)
Has the family been advised what to keep in their NGT tool kit? (Inc. spare NGT)
Has the latest NGT change been documented on the CCN referral form?
Have the family met the CCN team and know when they will next have contact?
Have the family been made aware of who to contact when they need support?
Has open access been completed/updated?

Competency for nasogastric tube insertion
Not required for discharge

Performance criteria	Parent/carer signature	Assessors signature and date
1.Insertion of a nasogastric tube
1.1 Parent to discuss confidently the signs of a misplaced tube and how they will manage this in their home setting.
1.2 Parent to discuss how they would safely measure the NEX measurement to ensure the NG tube is passed to the correct measurement for the CYP.
1.3 Parent to discuss the type of tube used and how often the CYP needs a NG tube replacement.
1.4 Parent to discuss the correct PH Aspirate for safe feeding.
1.5 Parent to discuss how they would safely secure the NG tube in place.
1.6 Parent to discuss who they would contact in case of an emergency or if they were concerned about their child’s skin integrity
2. Securing the tube
2.1 Parent to discuss and show how they would ensure the nasogastric tube is secured and how often the tapes need changing?
2.2 Parent to discuss how they would ensure skin integrity is maintained as best as possible and if there are any concerns who they would contact for support?

Statements	Assessors signature and date
As the registered nurse I confirm that the parent/carer understands this procedure and what actions to take. I have provided up to date evidence-based training today.

Sign-offs demonstrating competence in NGT insertion

Minimum of three sign offs. More to be competed as required for competency demonstration.

		Date	Assessor Sign and Print	Parent Sign and Print
ESSENTIAL	1
	2
	3
IF REQUIRED	4
	5
	6
	7
	8
	9
	10

Log of nasogastric tube insertions

Date and time of insertion	Size and length of tube	Nostril inserted (L/R)	Aspirate obtained (Y/N)	pH of aspirate	Inserted by name, signature and date

Contact numbers

We hope that you have found this information useful. If you have any questions, please contact us below:

CCN Team office phone: 01305 254279

Team email address: ccndorchester@dchft.nhs.uk

Address:
Community Children’s Nursing Team,
The Children’s Centre
Dorset County Hospital
Dorchester
DT2 9UY

Working hours: Monday to Friday, 9am to 5pm (excluding bank holidays).

Please note: We are NOT an emergency service.

We have an answerphone which is checked regularly during working hours.

If your contact is urgent, please contact the Paediatric Assessment Unit out of hours on 01305 254218 or Kingfisher Ward on 01305 254253.

For all consumables/equipment/order queries please contact in the first instance the Fresenius Kabi patient line: 0808 100 1990

For any other queries, please contact the Home Enteral Nutrition team: 01305 254895

Please leave a message following the answerphone if your call is not answered, as your message will be emailed out to the team to act on as soon as possible.

Feedback

Patient and family feedback is extremely important to our service and we value hearing from you: https://dchft.onlinesurveys.ac.uk/paediatric-specialist-and-community-nurses-questionnaire

About this leaflet

Author: Beth James, Community Children’s Nurse Specialist Practitioner
Written: December 2024
Approved: February 2025
Review date: December 2025
Edition: v1

If you have feedback regarding the accuracy of the information contained in this leaflet, or if you would like a list of references used to develop this leaflet, please email patientinformation.leaflets@dchft.nhs.uk

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