Page 1 of 2

NG Tube vs. PICC Line

PostPosted: Nov 06, 2004 4:58 pm
by MamaLily
I am revisiting my protocol, as DH and I are thinking about TTC again. And so I've been considering all of the options for treating HG.

Many of you know that I am a fan of an NG tube instead of a PICC line, and I thought maybe it would be helpful for others who are preparing if I posted my list of pros & cons - NG tube vs. PICC. I posted most of this a while ago on the old HuGS site...


I am pro-NG tube. This is from both my experience as well as the advice of my regular OB and three highly respected and informed perinatologists. I have also done a lot of research on the internet about PICC vs. NG tube.

If I ever have another baby, I will definitely have an NG tube before a PICC. In fact, a PICC line will be my very last line of defense...after steroids, NG tube, etc. My new peri said that it might be a great idea to think about an NG tube earlier in the pregnancy (before I lose so much weight and get so malnurished/dehydrated).

So, as I see it, here are the pros and cons of an NG tube:

PRO #1 - Very good nutrition. I was given something called "Jevity" (with fiber!) in the tube. Jevity contained ALL of the nutrition that my baby and I needed (except for a very small amount of iron). Since I really couldn't eat anything, I was soooooo grateful for that nutrition. Having the tube gave me peace of mind, because I knew that my baby and I would be okay. Frankly, this peace of mind alone would have been reason enough for me to have the tube. I have heard of problems from TPN (usu relating to liver function or fatty lipids? This was never an issue for me.)

PRO #2 - Low/No risk of infection. I think this is one of the biggest reasons to use an NG tube instead of a PICC. When PICC lines get infected, the consequences can be severe.

PRO #3 - Easy way to take meds/liquids. If you are unable to take meds by mouth, you can crush them up, mix with water, and insert into the tube with a syringe. If you can't drink any liquids, you can insert those into the tube. When I first had the tube, I was not allowed to take anything by mouth. Not even an ice chip! So the nurses put my meds through the tube. It was a great way to take meds!

PRO #4 - No pain. I never felt pain from the moment the tube was inserted until the moment it came out. I was uncomfortable (esp at first), but I was never in pain.

PRO #4 - Easy to transport. The pump was very small. The pump was connected to the bag of Jevity on one end and to the tube leading to my nose on the other end. My peri has had women go to work, go to movies, etc. with the pump. Because I felt so horrible, I didn't leave the house except for doctor's appts and an occasional night on my in-laws couch, but when I did leave it was very easy to just take my bag of nutrition with me.

PRO #5 - Easy to maintain. To keep the tube clear, 2-3 times a day my DH or my mom would flush the tube with warm water. This was absolutely painless; I didn't feel, taste, or smell anything at all.

PRO #6 - Possible to increase speed of feedings. In the hospital, they started the feedings very slowly. They waited a day or two after the tube was placed to actually begin the feedings. When they saw that my system was tolerating the feedings, they increased the amount until I was receiving all that I needed for a 24 hour period. I received the feedings continuously, 24 hours a day. At the advice of the nutritionist, when I came home, I increased the speed of feeding so that I was able to unhook myself for 3 hours a day. I could have tried to increase more (some women are able to get all the nutrition they need in fewer hours), but I was worried about pushing too much and ending up sicker. Next time around, I hope to be more aggressive about this.

PRO #7 - Can last for months. I had the NG tube for 6 weeks, but some women need to have the tube until delivery. As far as I can tell, the tube does not need to be replaced as long as it stays in place.

PRO #8 - Keeps the digestive tract working. From a medical/physical standpoint, this is an important benefit of the NG tube over the PICC.

PRO #9 - Bypasses the stomach...reduces risk of vomiting. My tube went down past my stomach, into my intestine. This was nice because it was impossible to vomit up the Jevity. So even when I vomited, I knew I would still get all the nutrients I needed.

PRO #10 - Easy to shower/bathe. When I took a bath, I simply unhooked the tube, flushed it with water, and sealed it off with a little cap. Then I tucked it behind my ear and was able to bathe.

CON #1 - Uncomfortable placement. In my opinion, this is the hardest part about getting an NG tube...having it put in (although the discomfort only lasted one night). My peri sent me to the radiology dept of the hospital for placement. They put some numbing gel in my nose and then the radiologist guided it down, with the help of an x-ray of some kind. The experience would have been much better if the radiologist had understood how sensitive my gag reflex was at the time. He was very harsh. The urge to vomit up the tube was very strong, but I felt that this was really the best option for me and my baby. So I mustered all the willpower I could and made it through those first few hours. After that, I really didn't even feel the tube and the urge to vomit it up was gone.

CON #2 - Must remain at 30 degree angle while receiving feeding. While a PICC carries the risk of infection, an NG tube carries the risk of the formula coming up into the lungs. I hesitate to even write this, because the risk is so low. My peri never worried about it and one particular nurse said there is no reason to worry about it. But, Kimber wrote to me that someone receiving tube feedings ought to avoid sedating meds because of the risk. As far as I can tell, remaining on a 30 degree angle basically takes away this risk.

CON #3 - Risk of dislodging tube. It is possible to dislodge the tube with lots of vomiting. I worried about this, but it never happened to me. I vomited many times with the tube and the placement remained perfect. I think having the tube inserted so far decreases the risk of dislodging the tube. The best scenario for tube feeding is when the amount of vomiting is reduced. Steroids in my case helped to control the amount of vomiting, so I was grateful to be given steroids at the same time as the NG tube (week 11 of my pregnancy).

CON #4 - Hard to swallow pills. At one point I was given an enormous pill. I can't even remember what it was...something for heartburn, I think. But it was HUGE and swallowing it was very hard, esp with the tube in place. It wasn't much of an issue with smaller pills, but it did take some getting used to. Next time around, I may just crush any large pills and insert them directly into the tube.

My opinion is that an NG tube is definitely worth trying! If you are interested in reading more about it, go to and search for hyperemesis. Here is a very interesting article, which states that an NG tube should be considered before TPN: And here is another article, which mentions that tube feeding can be an effective, non-invasive, less expensive alternative to TPN:

There are several articles there about NG tube and PICC lines. The conclusion there seems to be that an NG tube is a better option. Also, ... /index.php has good info about all the nutrition options for HGers.

I really hope everyone preparing for HG (or in the middle of HG) will carefully consider having an NG tube instead of a PICC line. There are so many HGers who have PICC lines without problems, but I would rather avoid the potential risks and infections.

I hope this will be of help to someone!

- Anna

PostPosted: Dec 01, 2004 2:41 am
by bibliojo
Thank you, Anna, for taking the time to compile and post this. It has been very helpful for me.


PostPosted: Dec 03, 2004 12:27 am
by MamaLily
Joanna -

I'm glad this was helpful...good luck as you prepare!

- Anna

PostPosted: Dec 09, 2004 9:50 am
by ladybug
Anna, could you PLEASE email me if you get this? I am getting ready to do an IVF cycle and I'm terrified of getting pregnant. I have had 9 pregnancies, one live birth and 8 miscarriages (talk about getting a bad deal, huh? all with HG) It is so horrible to be that sick for so long only to lose the baby. Anyway, I really need to try to prepare myself for the future. I have done everything imaginable and have studied HG and have read the book (No More Morning Sickness) and basically nothing works. I am a nurse, but never really gave the NG tube serious consideration because I just assumed it would give me the Gag Reflex From Hell. It sounds like it does not. I would be interested in talking to you more about it. I also knew I didn't want to do TPN/HA due to the stress on the liver. Thanks!

PostPosted: Apr 08, 2005 12:51 am
by teddi

Bumping this thread up. Thanks for the info. This is a hard one for me to imagine. I was ok with the PICC. No hint even of infection (did have an air embolism though :shock: ). I just have a hard time reconciling myself to imagining the actual tubing in the nose, etc. :? :(

Was it hard mentally? Or were you just so sick you didn't care? I'm scared of the thought of having the NG & still puking. Does it not matter if you still vomit alot? Does most of the nutrition get thru despite the vomiting?

With #1 I should have had regular hydration & some kind of feeding supplements. With #2 the PICC helped me stay better hydrated, but still, the malnourishment took it's toll. If there is ever a #3- I need, NEED, to make sure I get more nutrition.

PostPosted: Apr 08, 2005 7:39 am
by MamaLily
Teddi -

I definitely think you ought to consider a feeding tube if you ever decide to have another baby. (By the way, I can't believe that you can even consider it so soon after giving birth. You are amazing!)

To answer your questions, Yes - it was hard mentally to have the tube. Especially with my 1st pregnancy, when I was in such bad shape. I went to see a peri and the next thing I knew I had a tube in my nose and was in the hospital for 5 days. It was hard because I'd never in my life imagined needing something like a feeding tube. It was hard because the tube made me gag like crazy for the first few hours. But, once I reconciled myself to the fact that I desperately needed the tube, I was grateful for it. And the 2nd time around I knew that the tube was the best option - and that it would all be worth it!

It doesn't matter if you vomit a lot. The nutrition completely bypasses your stomach so you can't vomit up the nutrition. In 2 pregnancies with the tube, I never once vomited up a speck of the nutrition...and I did my share of vomiting with the tube! :? It was so nice knowing that my baby and I were getting all that we needed! That peace of mind changed the whole experience for me.

If you do decide to have another pregnancy, please talk with your doctor about the feeding tube. I can't tell you what a blessing it was for me with both pregnancies. And getting the tube earlier in my 2nd pregnancy made all the difference for me! I'd recommend it for anyone with severe HG.

Hope all is well with you and your little ones!

- Anna

PostPosted: Apr 08, 2005 7:54 am
by mammaclare
For Anna and anyone else...

Just wanted to give some clarity as provided by both a nurse friend of mine and then also my new case any of the HG mommies go in specifically asking for the feeding tube over a PICC (which is what I think I will do my next PG):

What you (Anna) are talking about, if the tube actually DOES bypass the stomach so that the Jevity can't be vomited, is technically an NJ tube. The tubing goes through the stomach (the "g" in most patients) and into the jejeunum (sp?). So to be sure we all get what we really are asking for, it may be important to clarify if we are the ones educating our docs.

If I am wrong, someone please tell me, but this is from my own conversations w/ health care providers.

PostPosted: Apr 08, 2005 3:12 pm
by teddi
oh, I have to clarify... I'm not TTC... just wanting to know for the future...planned or unplanned.. IF there is one.

PostPosted: Dec 07, 2005 6:52 pm
by JennyK
bumping this up


PostPosted: Dec 08, 2005 2:22 pm
by Bethers

PostPosted: Mar 13, 2006 9:26 pm
by teddi

Yes I'm going on a spree here

PostPosted: Mar 15, 2006 1:40 pm
by JennyK
I've had both PICC lines and NJ tubes, so I thought I would weigh in. Anna gave a very thorough and accurate summary of the pros and cons. I just have a couple things to add.

Be wary of clogging with the NJ tube. Flush it with water frequently and, if you can, dilute your Jevity so it's not as thick. I was on too high of a volume of Jevity to dilute it (it can't run more than 24 hours in a day), but that would have been preferable. I would also avoid putting crushed meds in the tube when other routes are available, i.e., zofran ODT and phenergan suppositories. Crushed meds can contribute to clogging.

Request that you be sedated for insertion. I had several tubes. For the first insertion I was given nothing to numb my nose or throat and it was truly awful. After that I got propofol for insertion. I have no recollection of the insertion, just woke up and the tube was in place. Propofol is category B, so I had no qualms about using it. There are other drugs available for sedation as well.

Take measures not to scare your toddler. My 2yo was scared the first time she saw me with the tube in. We cut up some extra tubing and my daughter, husband and parents all scotch taped it to the tips of their noses. This took the fear away, and after a day she didn't seem to notice the tube was on my nose and face. Sometimes she reattached her tube and pretended she was Lumpy (the baby elephant) from Pooh's Heffalump Movie.

I'm glad I gave the NJ a try and would encourage others to consider it. As Anna said, many people have no complications with a PICC line, but the possibility is out there. I'd prefer to avoid them, which is why I gave the NJ a try.

PostPosted: Jun 16, 2006 1:37 am
by megs4413
we're ttc and i am seriously considering the NJ tube in lieu of a PICC (which I'm almost sure it's going to come down to judging on my last HG experience). I'm wondering if the medicine is as effective coming through the tubing as it would be intravenously. I think the thing that finally stopped the vomiting was having my PICC set up with zofran on a constant drip with a demand dose possibility. I am concerned that if I do go with the NJ tube (I had TONS of complications with my PICC including infection) that the vomiting will continue because I can't get my meds in me the right way. I think i could probably do the NJ tube and have zofran injections or IVs, but that seems like a lot of tubes coming out of my body at once. Any ideas about how much the efficacy of the meds would be affected if I took them essentially orally as opposed to intravenously?

Also, is it a good idea to opt for the NJ tube early on? I know I will at least need regular IV hydration and I think once I hit 8 weeks I was no longer keeping anything down for days at a time. I didn't get help for a long time because of a retarded doc (who has now been exiled to :hgisland: ) I'm wondering how soon the NJ tube becomes necessary/makes sense. Is it when you can't keep hydrated or when you have lost a certain amount of weight? I want to be extremely proactive in my care this time. I will be starting treatment from when I get my BFP (already have the zofran) and I don't know how quickly I should pull the trigger on something like an NJ tube or a PICC line.....

Any advice is appreciated!

PostPosted: Jun 16, 2006 12:08 pm
by JennyK
I had those same questions with my second pregnancy. How soon do I need the tube? Certain amount of weight loss? Dehydration? Number of weeks?

Mine was put in at 7 weeks or so. I thought it was too soon, but my doctor was insistent. He wanted it based on my history, bloodwork, and condition in general. He was right. I felt better once I was getting calories in me, and even if I could have gotten by without it then I would have needed it later.

For me, IV zofran worked a hundred times better than ODT. When I switched from the NJ to the PICC I started a zofran pump through the PICC. Without a PICC, I think your choices would be SQ, which a lot of people do, or a peripheral. I've never heard of anyone using a zofran pump with a peripheral, but I don't know of a reason it couldn't be done.

PostPosted: Jun 19, 2006 12:24 am
by MamaLily
I've been thinking the same thing about timing of an NJ tube for my next pregnancy.

With my 1st pregnancy, I got my tube in around 10-11 weeks, which was WAY TOO LONG!!! I was in really bad shape and needed immediate hospitalization and a whole bunch of meds, IVs, steroids, etc.

With my 2nd pregnancy, I got the feeding tube closer to 7 weeks. It made a HUGE difference! I never spiraled down as far as with the first pregnancy, and so my body didn't have to play the "nutritional catch-up" game for so long.

For my next pregnancy, I'm seriously considering finding a doctor who will insert the tube as soon as I have bad nausea. I considered asking for the tube as soon as conception had taken place, but I'm sure that would be an uphill battle!! :D Do you think it's possible to get a feeding tube before actually vomiting? Well, I'm going to try for it! I honestly think that I would have a much better time of things if I had the tube even earlier than 7 weeks. I'm going to fight for it. (We're not ttc quite yet, by the way, so it may be a while before I test all of my plans.)

Also, the next time around I am going to insist on regular tests to determine my levels of potassium - and maybe other levels as well. I have never felt better during HG than the night I started on the feeding tube and received potassium supplements as well. I honestly could have done almost anything that night. The combination worked better than any drugs have ever done. I almost felt "normal."

Oh, and when I was on the tube I mostly took zofran by mouth. I did the dissolving kind when I was too sick to swallow even a pill. And I did get IVs occasionally to use for IV zofran.

Hope this helps and I wish you luck! I wish everyone could have the tube...even though HG still stinks, it is much easier getting all the nutrition you need every day. The nutrition nurses at my hospital said that HGers who get NJ tubes feel much more relief from nausea/vomiting than the women who get nutrition through PICC lines. Good luck!

- Anna

NG tube syndrome?

PostPosted: Aug 04, 2006 7:21 pm
by tlm5999
I was doing some research on NG because I've had 2prior HG preg. and only was given phen suppositories. I ended up losing 25 lbs with my first and 17 with my second. I came across something called NG tube syndrome it can damage the vocal cords. I sing for a living. Has anyone else heard of this? Or know the risk factor of it?
NG was sounding like my best option so far. Also does anyone have a picture of what it looks like? I couldn't find anything but diagrams?

PostPosted: Aug 04, 2006 8:02 pm
by JennyK
I haven't heard of it, but I haven't researched it either. I've had more than my share of PICC complications and am back to another NJ at 33 1/2 weeks. Here is a picture of me from just a couple days ago. There some from about 6 months ago in this thread:


PostPosted: Aug 22, 2006 2:26 am
by MamaLily
I know I'm late with this one, but I haven't noticed any problem since having feeding tubes with both of my pregnancies. You could talk with your doctor or a vocal coach about it. I'm a singer as well (although I definitely don't sing for money, lol) and I honestly can't tell a difference in my voice (speaking or singing) after having the tubes. I had a voice teacher in college tell me that if a doctor ever needs to stick something down your throat, you should tell the doc that you are a vocalist and you need him to be careful. Seems like common sense to me, but I guess doctors will take special precautions with your vocal cords...

Good luck! I highly recommend the feeding tube...with my next pregnancy, I'd like to have the tube in place as soon as I know I'm pregnant! It would save a lot of grief, vomiting, weight loss, etc.!

PostPosted: Jan 05, 2007 6:24 pm
by mommy2wyatt
Wow! Thanks for the info, I had no idea there was another option besides the picc! I had a picc placed when I was 10 weeks pregnant and it got infected while I was hospitalized at 20 weeks. Due to the infection in my blood it got in my eye and I now have permanent damage as in a scar on my retina. Basically I have a blind spot on my left eye. The Drs say there is nothing to fix it and I should be grateful not o be blind in that eye. I wish someone would have told me there was another option instead of the picc, also that someone would have told me about the rick of infection with the picc.
My little boy was just born on Dec 23rd so I'm not thinking about another one anytime soon, but it's good to know theres another option to the picc.

PostPosted: Aug 14, 2007 8:36 pm
by Buffy
I know I am very late to this topic but I though I would add my experiences with NG. I am Australian and I'm not sure what a picc is or whether it is offered here.

I had the NG inserted finally at 22 weeks and it was the turning point of my pregnancy. I felt the nausea ease almost immediately. Within three days I was able to consume some solids and liquids. I had severe reflux and the doctors believed that my stomach and oesophagus were ulcerated. The NG bypassed this and gave my stomach a chance to heal. I gained weight very quickly. After 4 weeks the tube was removed and i didn't vomit again after that. I did feel quesy and continue with meds up until my baby was born but it seemed to give me a chance to catch up and recover a little.