Feeding tubes: OG, NG, and transpyloric

(Version 1.0  7/19/200 - 8/17/2010)

Babies who are temporarily unable to nipple feed po due to immaturity, respiratory problems, or neurologic problems may be enterally fed via feeding tube.

Feeding tube size

Use a 5 or 6 French feeding tube for infants < 1000 g.

Use an 8 French feeding tube for infants > 1000 g.

Tube placement

Measure the distance from the tip of the nose to the ear down to the xiphoid process.

Insert the tube via either the mouth or the nose into the esophagus to this distance.

Confirm proper placement by

    1. aspirating stomach contents
    2. slowly injecting 0.5 – 1.0 cc of air into the feeding tube while auscultating over the stomach with a stethoscope.

Feeding tubes should be secured with tape during feeding.

Mouth care should be performed every 4 hours.

Bolus OG feeds

Check the residual before feeding.

  • Unless the residual is mucoid, return the residual to the infant and subtract the amount from the feeding unless otherwise ordered.

  • If the residual contains bile or blood or is > ˝ the previous feeding volume, hold the feed and notify the physician.

Administer feedings by gravity over 10 – 20 minutes.

Offer the infant a pacifier during gavage feeds for non-nutritive sucking, if tolerated.

The feeding tube should be clamped before removal.

The infant should be burped after feeding and placed prone or on the right side.

The OG tube should be removed in between feedings unless otherwise ordered or if the infant becomes apneic, bradycardic, cyanotic, or experiences choking or coughing without recovery.

Bolus feeds may also be administered as above via an indwelling NG tube.

Indwelling feeding tubes

Silastic feeding tubes may be left in place for a 1 month period.

Indwelling NG and OG tubes should be labeled with a bright green fluorescent sticker indicating time and date of insertion and depth of insertion.

The depth of insertion should be noted whenever an X-ray is performed to verify tube placement.

These stickers are an extra precaution to prevent rare but catastrophic iatrogenic gastric perforation.


Continuous OG feeds

Properly place and secure the feeding tube as above.

Connect the feeding tube to tubing, a volume administration set, and an infusion pump.

Place 4 hour volume of feeding in the volume administration set.

Make hourly checks on the infusion to ensure the proper flow rate.

Check gastric residuals every 4 hours.If the residual contains bile or blood or is > 2 cc AND > 2 hours volume, notify the physician to assess feeding tolerance.

Abdominal girth should be measured at least every 12 hours.

Change the volume administration set and the delivery tubing every 24 hours with breast milk and every 72 hours with formula.

Label the formula tubing with a green sticker stating the date and time the formula was changed.

Transpyloric feeds

Infants who are unable to tolerate gastric infusion of feeds due to severe gastroesophageal reflux or slow gastric emptying may be fed transpylorically.

Insert a Silastic feeding tube using the standard measuring technique (see above) and then advance the tube 2 – 3 cm further.

Passage of the tube into the duodenum may be facilitated by placing the infant right side down.

Confirm placement of the tube with an X-ray initially demonstrating the tip of the tube crossing the vertebral column.

The distance the properly-placed feeding tube is inserted should be noted in the nursing notes and on the collaborative pathway worksheet and verified every shift.

The infusion pump and tubing should be prepared as above for continuous feeds and the tubing labeled with a green sticker with the date and time started.

Formula and breast milk should be changed every 4 hours.

The infusion tubing should be changed every 24 hours for breastmilk and every 72 hours for formula.

The infant’s abdominal girth should be measured q 12 hours.

Stomach contents should be aspirated every 6 hours to check for reflux or tube dislodgement.

Resolved at Nursery Policy & Procedure meeting 7/19/00.


Doolittle G, Mills M. Continuous drip feedings in the very low birth weight infant. Neonatal Network 1992; 11: 31 –35.

Hill AS, Rath L. The care and feeding of the low-birth-weight infant. Journal of Perinatal and Neonatal Nursing 1993; 6: 56-68.

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