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Placement of NG Tube and NJ Tube

Placement of a feeding tube through the nose is a common procedure in children with cancer. A thin, flexible, hollow tube is passed through the nose, down through the esophagus, and into the stomach (NG tube) or intestine (NJ or ND tube). This allows nutrition support and medicines to be given through the feeding tube. Nasogastric tubes can also be used to remove air or other contents from the stomach.

If the feeding tube is placed using anesthesia, patients should not eat or drink anything by mouth for the specified amount of time before the procedure. It is very important to follow these NPO instructions. Patients may also have NPO instructions after the procedure.

  1. Placement of NG Tubes: What to Expect

    NG tubes are usually placed at the bedside while the patient is awake. It is important for patients to breathe normally and stay relaxed during the procedure. Swallowing air or water through straw can help advance the tube to its proper position.

    For patients who are awake for the procedure, placement of the NG tube involves these general steps:

    • The patient will be positioned with the head elevated or in an upright seated position.
    • Children may receive a medicine to help them relax during the procedure. In some cases, a topical anesthetic may be used to reduce pain or gagging.
    • The appropriate length of tube is estimated based on age and body measurements.
    • The tip of the feeding tube will be lubricated to allow it to pass more easily.
    • The patient will be told to look down so the chin is tucked toward the chest.
    • A nurse or other care team member will hold the tube and put it into one nostril. The tube will be moved slowly through the nasal passage.
    • The patient will be asked to swallow or drink a sip of water. This helps the tube advance to its correct position.
    • A test of the stomach contents or X-ray is used to make sure the tube is in the correct place.
    • The tube is secured to the face with medical tape to hold it in place.

    NG tubes are replaced on a set schedule, usually every 30 days or as otherwise instructed by the care team.

    Note: Procedures can vary depending on hospital policies, resources, expertise, and patient needs. Be sure to discuss your procedure with your care team.

    Illustration of a Nasogastric Tube through the nasal cavity of a person

  2. Placement of ND or NJ Tubes: What to Expect

    ND and NJ tubes are usually placed while the child is under anesthesia.

    Placement of the ND / NJ tube involves these general steps:

    • The patient will be taken to an interventional radiology or treatment room. Depending on medical center policies, a parent may be able to go with the patient until time for the procedure.
    • Children usually receive general anesthesia. Heart rate and blood pressure will be monitored throughout the procedure and recovery.
    • The tip of the feeding tube is lubricated to allow it to pass more easily.
    • Under fluoroscopy guidance, the tube will be placed in one nostril and moved slowly through the nose, down the esophagus, and into the stomach.
    • Using imaging, the tube will be guided through the stomach into the correct position in the intestine. A guide wire may be used to help direct the tube placement.
    • The end of the tube outside the body is secured to the face using medical tape.

    Note: Procedures can vary depending on hospital policies, resources, expertise, and patient needs. Be sure to discuss your procedure with your care team.

    Illustration of a Nasojejunal Tube through the nasal cavity of a person

Complications of nasal feeding tubes

For many children, NG and other nasal tubes are an important part of cancer care. During placement, risks include pain or discomfort, problems related to anesthesia, and injury to structures of the digestive tract. It is also possible that the procedure will have to be stopped if it is not safe to continue. Sometimes, the care team will decide that the child will need to have a feeding tube surgically placed.

After the procedure, the most common complications of NG tubes are pain and irritation of the skin or nose due to the tape or pressure of the tube. Other problems include movement of the tube out of position, tube blockage, digestive problems, and infection.

Serious complications are rare, but they do occur. Be sure to ask questions, and follow all instructions given by the care team.

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Reviewed: December 2018

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