Checking G-tube placement

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So, I'm curious. (I'm not really sure where to post this!)

In class we are taught to check placement by residual pH.

The hospitals in our area still have policies saying to inject air and listen. Despite that there is evidenced based practice saying it's not an effective way to check placement. Other hospitals in the state have realized that and changed policies EIGHT years ago.

So my question is, is this really just my area that still does it that way?

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In skills check off we listen for bowel sounds first, then push air, pull out residual, put back in. Pull for residual. Place back in (ph strip too). If you have more than 75 put back in come back 30 min. If you get that again. Notify MD. Last check, X-ray. Out in the field we didn't do PH strips at any of our clinic sites for flushes or feedings.

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Specializes in Complex pedi to LTC/SA & now a manager.

75 is an arbitrary number usually it is 50% of the previous feed volume.

Instilling air is NOT the best choice especially in pediatrics or a patient with a fundoplication. pH of gastric secretions is the best choice. Presence of residual, x-ray confirmation are others. I was taught and policy where I work is that Instilling air is a last resort but stick with small volume plus if the tube is in the peritoneal space you will still hear the air and may assume placement when in fact it is not.

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The hospital I was JUST in for clinicals does the air thing. Our instructor kind of shook her head when she was telling us, but it's apparently still live and well

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Yes,we do air too, most hospitals have not changed their policies, which takes a long time sometimes-like an old sacred cow. However, NCLEX and real life/hospital policy are 2 different things. In the wonderful world of NCLEX, checking pH is correct, so I was taught as well

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It's not "the wonderful world of NCLEX," and I would caution you to stop being so cavalier about that. It is never just a joking matter to assure that best practices for patient safety are observed in any patient care setting. There are plenty of references available to determine what best practices are, and I am pleased to see the OP using the critical thinking process to find out more.

Correct placement of nasogastric tubes is critical for patient safety, and pH testing offers an evidence-based method to assist in this process (Tho PC, Mordiffi S, Ang E, Chen H. Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. Int J Evid Based Healthc. 2011;6:51–60. doi: 10.1111/j.1744-1609.2010.00200.x. [PubMed][Cross Ref])

Please also see the National Guidelines Clearinghouse, National Guideline Clearinghouse | Gastric tube placement verification.

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It's not "the wonderful world of NCLEX," and I would caution you to stop being so cavalier about that. It is never just a joking matter to assure that best practices for patient safety are observed in any patient care setting. There are plenty of references available to determine what best practices are, and I am pleased to see the OP using the critical thinking process to find out more.

Correct placement of nasogastric tubes is critical for patient safety, and pH testing offers an evidence-based method to assist in this process (Tho PC, Mordiffi S, Ang E, Chen H. Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. Int J Evid Based Healthc. 2011;6:51–60. doi: 10.1111/j.1744-1609.2010.00200.x. [PubMed][Cross Ref])

Please also see the National Guidelines Clearinghouse, National Guideline Clearinghouse | Gastric tube placement verification.

WHAT? Pulling hair out. Blah blah blah. Your wrong about the NCLEX thing for real. Im so through with you and this site. I hope there is someone I can complain to about you.

By the wau, if you read my whole post, youd have seen that I said pH was best way according to school and NCLEX.

OVER IT.

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Specializes in Hospice.

Uh oh.

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We still push in air at my school and at clinical sites.

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this was only ever applicable to NG tubes, never Gtubes...pH is the way to go.

We still push in air at my school and at clinical sites.
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WHAT? Pulling hair out. Blah blah blah. Your wrong about the NCLEX thing for real. Im so through with you and this site. I hope there is someone I can complain to about you.

By the wau, if you read my whole post, youd have seen that I said pH was best way according to school and NCLEX.

OVER IT.

:unsure: Um... It really isn't a big deal. GrnTea is one of the most helpful members on here IMO, I hardly see much you can complain about.

Not to stir the pot...

Anyways, thank you to everyone who answered. My advanced skills instructor has always been annoyed the hospitals in our area still use the air method. She is from only about an hour away where they changed their policy on this in 2006 (only one year after recommendations changed).

My clinical instructor this semester who works at the same hospital we had clinicals at seemed to disagree on the way of checking placement; and didn't seem to buy that pH is the best method. She didn't even acknowledge that it truly is the best way and that the hospital was just behind. I don't know how you can deny evidenced based practice but I sure know when to drop a subject when the conversation goes that way.

Eight years still seems like a long time to change something like that, though. Interesting to see that it isn't just my area though.

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what I want to know, is how did it ever get into a P+P when it was NEVER appropriate in the first place?

:unsure: Um... It really isn't a big deal. GrnTea is one of the most helpful members on here IMO, I hardly see much you can complain about.

Not to stir the pot...

Anyways, thank you to everyone who answered. My advanced skills instructor has always been annoyed the hospitals in our area still use the air method. She is from only about an hour away where they changed their policy on this in 2006 (only one year after recommendations changed).

My clinical instructor this semester who works at the same hospital we had clinicals at seemed to disagree on the way of checking placement; and didn't seem to buy that pH is the best method. She didn't even acknowledge that it truly is the best way and that the hospital was just behind. I don't know how you can deny evidenced based practice but I sure know when to drop a subject when the conversation goes that way.

Eight years still seems like a long time to change something like that, though. Interesting to see that it isn't just my area though.

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