Checking G-tube placement

[Compassion_x]

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?

[Mainergal2000]

Plus if you are in school we still have to think Nclex world not real world right now as we were told. I had ask the instructors about it and even though we get the right info on here, it pertains to the real world and to be careful of what is said on here because it will mess up students for Nclex, even though the nurses on here are very , very helpful and appreciate your help if questions are needed to be answered. Which they do make sense and our instructors are amazing! X-ray after placement, air 10-20 ml before feedings or flushes. One of my study buddies's mom is an LVN was looking at our answers on some stuff and she said we were wrong on some answers and we changed it. Well that was per her facility and what she has always done and they ended up wrong.

[nurseprnRN, BSN, RN]

There is no reason whatsoever that "real world" can't be made to conform with "best practice." As a matter of fact, I recommend it. Just because nobody else checks NG pH before inserting something doesn't mean you can't.

[Compassion_x]

There is no reason whatsoever that "real world" can't be made to conform with "best practice." As a matter of fact I recommend it. Just because nobody else checks NG pH before inserting something doesn't mean you can't. [/quote']

I agree with this. If something is proven to be best then it shouldn't take so many years for p&ps to change!

[SL2014]

In general assessment we do air.

If this is an initial use we...

1. Is the patient coughing or blue?

2. Air

3. KUB

[SL2014]

I have NEVER seen a PH test strip in my life. By the way. I don't even think our hospital has them and we have 800 beds.

[NicuGal, MSN, RN]

We don't have pH strips on our floor either

[lindseylpn]

I have NEVER seen a PH test strip in my life. By the way. I don't even think our hospital has them and we have 800 beds.

Me either. I was taught to check placement with air and check residual, that's been the policy everywhere I've ever worked too.

[nurseprnRN, BSN, RN]

And the last few posts point out how long it takes for good, solid evidence-based practice to reach actual practice.

You guys, get out there and be pioneers for better practice in your facilities. Print out the guidelines that appeared earlier in this thread, get on the agenda to present them to the policy and procedure or therapeutics committee (yes, there is one), have staff development do the inservices around the house, and get the pharmacy or central supply to give out the pH tape as floor stock.

You'd be surprised how gratifying it is to lead practice instead of just saying, "Gee, we've always done it this way." Really.

Just because nobody else checks NG pH before inserting something doesn't mean you can't.

I just bought a roll of litmus indicator.

[Esme12, ASN, BSN, RN]

I just bought a roll of litmus indicator.

I secretly carried mine too.

Here is the deal...I was once told by an administrator with a PhD and the educator/CNS for a large Boston facility that using litmus paper presents issues for "competency" and "QA" documentation as litmus paper if breached can be inaccurate and that the staff would have to have color blindness/variance testing to institute hospital wide litmus testing as a standard. That it is used sparingly, under sontrolled circumstances...like testing pregnant women to see if it is amniotic fluid or urine...and not system wide as a standard due to the logistics of documenting competency and QA control.

This is one of the reasons why some ED's have stopped strip testing urines and send them off to lab for the "real" dip test/result.

While use may use it for your own piece of mind...you cannot document that is how you tested for placement for it falls outside policy and procedure and isn't considered standard if not approved for use by the facility. Just like I carried my own pocket pulse ox....for it was inevitable that one could not be found when I needed it....but I had to always check and document the one that was checked/calabrated by biomed owned by the facility.

I know there will be a difference of opinion with this.....however....Changing the culture and procedure isn't as easy as it seems.

I secretly carried mine too.

Here is the deal...I was once told by an administrator with a PhD and the educator/CNS for a large Boston facility that using litmus paper presents issues for "competency" and "QA" documentation as litmus paper if breached can be inaccurate and that the staff would have to have color blindness/variance testing to institute hospital wide litmus testing as a standard. That it is used sparingly, under sontrolled circumstances...like testing pregnant women to see if it is amniotic fluid or urine...and not system wide as a standard due to the logistics of documenting competency and QA control.

This is one of the reasons why some ED's have stopped strip testing urines and send them off to lab for the "real" dip test/result.

While use may use it for your own piece of mind...you cannot document that is how you tested for placement for it falls outside policy and procedure and isn't considered standard if not approved for use by the facility. Just like I carried my own pocket pulse ox....for it was inevitable that one could not be found when I needed it....but I had to always check and document the one that was checked/calabrated by biomed owned by the facility.

I know there will be a difference of opinion with this.....however....Changing the culture and procedure isn't as easy as it seems.

Of course... no personal diagnostic equipment is permitted (whistling, while looking up and away to avoid eye contact).

To be counted as legit, the litmus paper would have to come from the lab and be QA'd just like the UA strips, AccuChecks, and UPTs. Still, if the aspirate didn't show up as acidic, I'd be pretty reluctant to put anything down the tube pending additional confirmation.

[Esme12, ASN, BSN, RN]

Of course... no personal diagnostic equipment is permitted (whistling, while looking up and away to avoid eye contact).

To be counted as legit, the litmus paper would have to come from the lab and be QA'd just like the UA strips, AccuChecks, and UPTs. Still, if the aspirate didn't show up as acidic, I'd be pretty reluctant to put anything down the tube pending additional confirmation.

...... did you say something?