Verification of NG tube placement

We X-ray all NG tubes used for feeding no matter what type of tube it is.....The only time we dont is if we set it up to suctioning.

Ive seen many ngt's go past the cuff in an intubated patient or patietn with a tracheostomy. Ive seen many ng's go in the lung and the patient had no cough reflex. Ive seen tube feeding infused into the lung after two nurses verified placement.

the safest way to ensure proper placement is with a CXR........

We do a PCXR for all NG and OG tube placements where the patient is unable to talk to us. If there is to be a tube feeding, it is also xrayed.

If we're simply doing a decompression or a GI bleed work-up, then we do not xray them.

Chip

Our trust has just banned the whoosh air test. placement has to be confirmed by Ph indicator paper. only if there is a doubt over placement is a chest xray done.

I recently read that auscultating for air is very unreliable. This seems to confirm it.

This may a little late for you, but, our hospital just redid our policy also. We changed ours to auscultation, aspiration and check the pH of the gastric content. If really in doubt, x-ray. We looked at the research when redoing ours.

I have been reading the posts (sorry I am joining the discussion late). We are looking at redoing our policies/procedures but have to use evidenced based practice no more that 2-3 years old. Having trouble finding any that recent. Can anyone direct me to a good site? This is a pediatric/PICU/NICU area.
Thanks

we only get KUB if we are going to be using the NG for meds, if not we just use the irrigation kit and listen for the aaahhh... 'wooooosh' and return.

-H-RN

Where I practice we never check NG placement. Yet with a dobhoff a KUB is protocol but we still need an order!?! And from my practice, if you place a dobhoff and the KUB shows its not in place leave it! Ultrasound will not place it unless it has been attempted 3x on the floor. So do not remove it and order US guided placement. They made me replace it it attempt an additional 3x before they would place the dobhoff.