Enteral feeding tubes, including nasogastric (NG) tubes and percutaneous endoscopic gastrostomy (PEG) tubes, are commonly used to provide nutrition, hydration, and medications to patients who cannot eat orally. Proper tube care is a vital nursing responsibility and a frequently tested topic on the NCLEX. Every nurse and registered nurse must understand how to safely manage these devices to prevent complications and promote patient comfort.
This article reviews essential nursing care for patients with NG and PEG tubes, focusing on assessment, interventions, and NCLEX priorities.
Understanding NG Tubes vs PEG Tubes
Nasogastric (NG) Tubes
- Inserted through the nose into the stomach
- Used for short-term feeding or gastric decompression
- Common in acute care and post-operative settings
Percutaneous Endoscopic Gastrostomy (PEG) Tubes
- Surgically placed through the abdominal wall into the stomach
- Used for long-term enteral nutrition
- Common in patients with stroke, neurological disorders, or chronic illness
From a nursing standpoint, care principles are similar, although PEG tubes require additional stoma care.
Nursing Assessment Priorities
Before administering feedings or medications, the RN nurse must perform a thorough assessment.
Key assessment points include:
- Tube placement verification
- Patency of the tube
- Condition of surrounding skin or stoma
- Presence of abdominal distention or discomfort
- Residual gastric volume (as ordered)
Accurate assessment helps prevent aspiration and feeding intolerance.
Verifying Tube Placement (NCLEX Focus)
Correct tube placement is a high-priority NCLEX concept.
- Confirm placement per facility policy
- Check external tube length markings
- Assess aspirate appearance when appropriate
- X-ray confirmation is required for initial NG tube placement
⚠️ NCLEX Tip: Never rely on air bolus auscultation to confirm placement.
Nursing Interventions for Enteral Feeding
Safe Feeding Practices
The nurse should:
- Elevate the head of the bed 30–45 degrees
- Verify tube placement before feeding
- Flush the tube before and after medications
- Administer feedings at prescribed rates
These steps reduce the risk of aspiration and tube occlusion.
Medication Administration Through NG and PEG Tubes
Medication safety is a core part of nursing care.
Best practices include:
- Using liquid medications when possible
- Crushing medications only if allowed
- Flushing between medications
- Never mixing medications with feeding formula
This approach minimizes drug interactions and tube blockage.
Skin and Stoma Care for PEG Tubes
Proper stoma care prevents infection and skin breakdown.
The registered nurse should:
- Clean the site daily with mild soap and water
- Rotate the external bumper as ordered
- Monitor for redness, swelling, or drainage
- Keep the area dry
Early detection of infection improves patient outcomes.
Preventing Common Complications
Potential Complications Include:
- Aspiration pneumonia
- Tube displacement
- Infection
- Clogged tubes
- Diarrhea or constipation
Ongoing nursing assessment and timely intervention are essential for prevention.
Patient and Family Education
Education supports safe care at home and in long-term settings.
Teach patients and caregivers to:
- Check tube placement and secure tubing
- Recognize signs of infection or aspiration
- Flush the tube regularly
- Maintain proper positioning during feedings
Education is often emphasized in nursing bundle resources.
NCLEX Focus: NG and PEG Tube Care
For the NCLEX, remember:
- Verify placement before feedings
- Elevate the head of the bed
- Use proper flushing techniques
- Monitor for aspiration and infection
- Never crush enteric-coated medications
These points frequently appear in exam questions for RN nurses.
Why This Topic Matters for Nurses
NG and PEG tube management is common across many care settings. A knowledgeable registered nurse plays a key role in preventing complications, ensuring adequate nutrition, and supporting patient dignity.
Mastering this topic enhances both clinical competence and NCLEX readiness.