[Bwick]

Help! I'm reviewing our enteral nutrition policy. I would like to see that we get a chest X-ray or KUB to verify placement in a patient with an NG tube. Basically if anything is going into the tube (meds and/or feeding) we should have more evidence of placement than listening for air.
What does your hospital do?
Thanks

[Spidey's mom]

X-ray check for placement.

steph

[RNPATL]

We use a lot of dobhoff's at my hospital and they are xrayed for placement. For a standard NG tube (levine) - we do an xray for placement once, but then for continued placement verification, we rely on the nurses assessment through ascultation. Of course, anytime the nurse is uncomfortable with placement, she can call and get an order to double check placement, but it is not a general standard of practice unless the nurse feels it is necessary.

[meownsmile]

We do a x-ray for placement unless it is completely obvious that it is in the stomache. If you get 500ml of green/brown or orange yuck when you connect to suction or gravity, its a pretty good bet you are in the stomache

[Spidey's mom]

I placed a ng tube in an intubated patient - physician was not concerned "there is no way an ng tube will go into the lungs with the patient being intubated". Auscultated - I heard air over the stomach. We x-rayed as per protocol . . the physician said "steph, come here for a sec" . . . . .walked over to the x-ray and there was the ng tube in the bronchus.

Never say never.

steph

[humglum]

Thankfully, its very rare we have a kid with an NG. Usually that would just be temporary until they can get a GT button. We'll check initial NG placement with x-ray and auscultate air into stomach to verify placement before each usage. I also aspirate gastric fluids not only to check placement but also to assess residual.

[sjt9721]

Many of our procedural policies are referenced by a clinical skills text written by Perry & Potter. The book recommends aspirating & checking pH to determine if the tube is placed correctly. (Keeping litmus paper on the units leads to a point-of-care issue with lab...) However, I'm a fan of auscultation & x-ray.

[Tweety]

We never check with an Xray on NG tube placement. If we hear air over the stomach and aspirate gastric contents, we proceed to use it.

The smaller tubes called KEO tubes or Dubhoff tubes, that are supposed to go into the duodenum we do check with an Xray. Usually, you can tell when you hit a bronch as the patient coughs and turns red, but not always. Happened once that we hit a bronchous and the patient was alert and asymptomatic.

[mommatrauma]

Originally Posted by Tweety

We never check with an Xray on NG tube placement. If we hear air over the stomach and aspirate gastric contents, we proceed to use it.

The smaller tubes called KEO tubes or Dubhoff tubes, that are supposed to go into the duodenum we do check with an Xray. Usually, you can tell when you hit a bronch as the patient coughs and turns red, but not always. Happened once that we hit a bronchous and the patient was alert and asymptomatic.

what she said

[barefootlady]

Agree with Tweety. One thing I noticed recently, staff nurse did not verify placement everytime he used tube. That is a big NO-NO in my book. Agree on litmus paper but has been years since I have actually had paper available. Doctor usually orders stat xray to check rather than wait for pharmacy to get paper. Wow, all of this points up to me again and again how long I have done this stuff. LOL