Begin by anchoring the tube across the bridge of the nose and along the cheek using a hypoallergenic split-tape or H-loop technique, then overlay a transparent dressing such as Tegaderm or Hypafix to waterproof the site and allow staff to inspect the skin beneath. Confirm placement first by aspirating gastric contents and testing the pH (ideally ≤5.5), and document the centimetre marking at the nostril so any later shift catches dislodgement early. Choose a nasal bridle for confused pullers or long-term feeding where tape repeatedly fails.
This guide covers securing a nasogastric tube, walking through skin prep, split-tape and H-loop fixation, dressing choice, bridle selection, placement checks, and re-taping routines for bedside clinicians.
Why Securement Is a Safety Priority, Not an Afterthought
A nasogastric (NG) tube resting against the nasal septum pulls with every cough, swallow, and head turn. Over hours, that tension flattens the soft tissue of the naris and erodes skin never designed to bear load. You will not see it happening, because opaque tape hides the damage until the dressing comes off and the bridge is already raw.
Dislodgement Drives the Worst Outcomes
Dislodgement, outward migration, and accidental removal account for the majority of NG-tube-related patient harm, including aspiration pneumonia when feeds track into the airway and wrong-route feeding when a tube silently coils in the oesophagus or pharynx. A confident fixation method reduces repeat insertions, wasted clinician time, and the distress you feel each time a fresh tube is pushed back through the nostril.
Regulators in the UK (NPSA, HSIB, NCEPOD) classify every misplaced NG tube as a “never event,” which places securement and verification on the same safety continuum rather than treating them as separate tasks.
Pressure Necrosis Is the Hidden Cost
Poor fixation pulls tension across the nasal bridge, producing pressure necrosis that often goes unnoticed under opaque tape. A transparent dressing overlay lets you inspect skin without lifting the adhesive, and rotating the fixation site every few days prevents the cumulative trauma that turns a small redness into a full-thickness wound.
That cumulative trauma is exactly what you reduce when you prepare the skin and supplies correctly before any adhesive touches the patient.
Prepare the Patient, Skin, and Supplies Before You Tape
Preparation decides whether the fixation holds for three hours or three days. Measure the tube length with the NEX (nose-ear-xiphisternum) method and record the centimetre marking at the nostril before any fixation begins, because that number is the baseline you compare against every shift.
Confirm Gastric Position Before You Secure
Aspirate gastric fluid and test the pH (ideally ≤5.5), or follow local X-ray or capnography protocol before securing. A tube that looks taped in but sits in the wrong place is a never event waiting to happen; securement without verification turns a safety step into a liability.
Skin Assessment and Supply Checklist
Cleanse and dry the nasal bridge and cheek, then assess skin integrity. Apply a skin barrier such as Cavilon no-sting film or a Duoderm thin dressing where redness, moisture-associated skin damage, or fragility is already present, because tape adheres poorly to damp or inflamed skin and pulls harder on removal.
- Hypoallergenic tape: 1–2 cm wide, paper or silk, for the base strip across the nasal bridge.
- Transparent dressing: Tegaderm or Hypafix to overlay the fixation and waterproof it.
- Skin barrier: Cavilon no-sting film or Duoderm for fragile or reddened skin.
- Tape scissors: blunt-tipped to prevent shears near the tube.
- Backup fixation: commercial NG holder or nasal bridle kit for high-risk patients.
- pH testing strips: for the placement confirmation step before taping.
Match the Fixation Method to the Patient in Front of You
No single fixation fits every patient. The right choice depends on skin condition, length of feeding course, cognitive state, and ward policy on adhesives. Matching the method to the risk profile prevents both under-securement (and dislodgement) and over-securement (and skin breakdown).
| Method | Best For | Limitations |
|---|---|---|
| Split-tape / H-loop | Compliant adults, short-term feeds, intact skin, low pull risk | Loosens with moisture or facial movement; no skin window for inspection |
| Tegaderm or transparent overlay | Moist or diaphoretic faces, staff needing quick skin checks, layered fixation | Adhesive allergy risk; less secure alone without a base tape method |
| Commercial NG holder / clip device | Long-term feeds, restless patients, ward policy limiting adhesive use | Higher cost; sizing issues on paediatric or atypical facial anatomy |
| Nasal bridle | Confused “pullers,” repeated self-removal, long-term feeding, post-burn or facial surgery cases | Insertion skill required; patient consent and capacity assessment needed |
When to Escalate to a Bridle
A bridle (such as the AMT Bridle) loops a thin magnetic-tipped tape around the vomer bone inside the nose and clips to the NG tube, anchoring it without facial adhesive. Escalate after one or two failed tape fixations in a confused puller, or at the outset for any patient with a documented history of self-removal, because the cost of a third dislodgement usually outweighs the procedural complexity of bridle insertion.
Knowing when to escalate to a bridle only matters once you can actually execute a fixation that holds without damaging the skin underneath.
Step-by-Step Technique for a Durable, Skin-Safe Fixation
A layered approach outperforms any single tape method. A base strip across the bridge absorbs the initial pull, a split-tape or H-loop anchors the tube itself, and a transparent overlay waterproofs the whole construction while leaving the skin visible.
Apply the Base Strip and the Split-Tape Pattern
Apply the base strip across the nasal bridge first, oriented horizontally so it sits flat against the bone. Then secure the tube with a split or H-pattern: cut a 5–7 cm length of tape, split it lengthwise from one end to leave a Y-shape, wrap the two tails around the tube just below the nostril, and lay the uncut portion flat across the bridge. The loop absorbs traction so that any pull tugs the tape, not the naris.
Anchor the Cheek Strip and Add Slack
Place a second strip along the cheek, leaving roughly 2–3 cm of slack between the nasal anchor and the cheek anchor to absorb movement. That slack is deliberate, because a tight cheek strip acts as a lever and multiplies the force transmitted to the nostril every time you turn your head.
Overlay With Tegaderm or Hypafix
Apply a transparent dressing such as Tegaderm or Hypafix over the tape to waterproof the fixation while keeping skin visible for inspection without lifting tape. Press the overlay firmly around the tube exit point so sweat, feed spill, or nasal secretions cannot creep under the adhesive and loosen it.
Document the Baseline
Record the centimetre marking at the nostril, the fixation method used, the products applied, and the skin assessment in the notes so every shift starts from the same baseline. A patient whose tube sat at 55 cm on Tuesday night should still sit at 55 cm on Wednesday morning, and that comparison only works when the number is written down.
A written length means nothing if it slips the moment the patient moves, so the next step is confirming the line actually stayed put.
Verify Placement, Monitor Skin, and Plan Routine Re-Taping
Securement without verification is half a safety step. Re-check the centimetre marking at the nostril every shift and compare it with the documented baseline; any unexplained change of even 2–3 cm triggers a full placement check rather than a quick visual reassurance.
Repeat pH Testing Before Each Feed or Dose
Recheck the pH of aspirate before every feed or medication dose, escalating to X-ray when pH is borderline, unobtainable, or after any dislodgement event. Continuous enteral feed raises gastric pH toward 6, so a single reading of 5.5 one morning does not exempt you from checking the next.
Daily Skin Inspection Under the Dressing
Examine the nasal bridge and cheek beneath the tape at least once daily, using the transparent window or a planned dressing change to score early redness or blistering. A simple 0–3 scale (0 = intact, 1 = non-blanchable erythema, 2 = blistering, 3 = skin loss) tracked in the notes catches early pressure injury before it becomes a wound that delays feeding.
Replace, Don’t Reinforce
Replace loose, wet, or soiled tape immediately rather than reinforcing it with another strip on top, because layered adhesives grip harder on removal and strip more epidermis with each change. Re-tape on a scheduled cycle (commonly every 3–5 days) to prevent adhesive build-up and to give the skin a clean window for inspection.
Troubleshoot Dislodgement, Manage Pullers, and Know When to Escalate
Partial dislodgement is the most common failure mode, and the rule is simple: if the tube has moved outward more than a few centimetres or the centimetre marking no longer matches the documented value, stop feeds, resite, and reverify. Never advance a partially withdrawn tube back into position, because the side ports may now sit above the gastric inlet or coil in the oesophagus.
Managing Confused or Pulling Patients
When tape fixation fails once or twice in confused or pulling patients, step up to a nasal bridle and document a formal capacity assessment alongside Mental Capacity Act considerations. A bridle does not replace a best-interest decision and a family conversation, but it does prevent the third dislodgement in 48 hours that usually forces an emergency reinsertion at night.
Paediatric Adjustments
In children, use smaller tape strips, lower-tension loops, and parent-held comfort; avoid bridles unless discussed with the paediatric team and a senior nurse, because paediatric nasal anatomy and skin fragility make both tape trauma and bridle insertion higher risk. Distraction, sucrose for infants, and a parent cupping the head during re-taping often achieve what an extra adhesive strip cannot.
Documentation and Audit
Record every event, including dislodgement, skin injury, bridle insertion, and verification result, so the team can spot patterns and audit against local NG safety standards. A ward that tracks dislodgement rates per 100 tube-days will see within weeks whether a new fixation method is working or whether confused patients need a different escalation pathway.
When to Escalate Beyond the Ward Team
Escalate to a senior nurse, tissue-viability link nurse, or nutrition team when skin integrity scores reach 2 or above, when a bridle fails to control pull behaviour, or when the patient meets criteria for a percutaneous endoscopic gastrostomy (PEG) instead of ongoing nasogastric feeding. Long-term NG feeding in a chronic puller is rarely the safest answer; the conversation about a more permanent feeding tube belongs on the timeline from day one.
Bottom line: anchor the tube across the bridge and cheek with a layered tape method, confirm placement with pH before every feed, inspect the skin daily through a transparent window, and escalate to a bridle the moment a confused patient shows that tape alone will not hold. Document the centimetre marking, the fixation method, and every shift check, because the number on the notes is the comparison that catches dislodgement before it becomes harm.
FAQ
What is the best way to secure a nasogastric tube?
The best fixation is a layered system: a hypoallergenic base strip across the nasal bridge, a split-tape or H-loop anchoring the tube itself, and a transparent Tegaderm or Hypafix overlay so staff can inspect the skin. Match the method to the patient’s pull risk, and escalate to a nasal bridle if tape fails once or twice in a confused patient.
How often should an NG tube be retaped?
Replace loose, wet, or soiled tape immediately rather than layering new strips over old ones. For stable patients, schedule a full re-taping every 3–5 days to prevent adhesive build-up and to give the nasal bridge a clean inspection window.
Can an NG tube be secured without tape?
Yes, for high-risk patients. A nasal bridle loops a thin tape around the vomer bone inside the nose and clips to the NG tube, providing securement without facial adhesive. Commercial NG holder or clip devices also work for patients with sensitive skin or ward policies that restrict adhesive use.
Why does my nasogastric tube keep coming out?
Repeated dislodgement usually points to inadequate fixation for the patient’s pull behaviour, moisture loosening the adhesive, or a fixation method that does not match the patient’s facial anatomy. Escalating from tape to a nasal bridle, switching to a transparent overlay that grips better on moist skin, or assessing whether the patient needs a more permanent feeding tube are the next steps.
How do you prevent nasogastric tube dislodgement?
Anchor the tube across the bridge and cheek with a layered tape method, allow a small loop of slack between nose and cheek to absorb traction, document the centimetre marking at the nostril, and check it every shift. For confused pullers, escalate to a nasal bridle after one or two failed tape fixations.
What tape is used for NG tube fixation?
Hypoallergenic paper or silk tape, 1–2 cm wide, is the standard base strip. Most wards layer this with a transparent dressing such as Tegaderm or Hypafix to waterproof the fixation and to leave a skin-inspection window; skin barriers like Cavilon or Duoderm go underneath when the bridge is fragile or already reddened.
