checking NG tube placement

gwenith, BSN, RN · Sep 27, 2003

All of the above. LOL and as most are put down at the time of intubation we will also check where it is on X-ray.

Liddle Noodnik · Sep 27, 2003

Originally posted by gwenith
All of the above. LOL and as most are put down at the time of intubation we will also check where it is on X-ray.

Y'know, I polled my coworkers one night and NOT ONE of them check for placement after it is put in and tube feeds are started!

I came from the "school" that you check placement (with air and stethescope) at the very LEAST q 8 hours. Them suckers can migrate out so easily, especially considering the tape and/or funky holding tape thingy get all wet/sweaty/greasy from sitting on a nose!

gwenith, BSN, RN · Sep 27, 2003

Not only that Zoeboboey but I did some research for a lecture and had to smoothe down my hair when I learnt how many migrate up the oesphagus undetected. Caught it once - by auscultation and had the devils own difficulty convincing my co-workers that I was right - different unit different colleagues.

Usually we try to nurse people 20 - 30 degree head up tilt to reduce this.

Lorus · Sep 27, 2003

Whenever im keeping the HOB ~30 degrees, im thinking about the obvious- reducing aspiration risk. Good to remember that this positioning will also help reduce tube migration. Good call gwenith. Heck even PEGs will wander a bit, and they are secured with more than just wet tape.

RNKPCE · Sep 27, 2003

If it is for suction we just listen with stethoscope over epigastric area after instillation of air, also check fluid suctioned out. If it is for feeding the initial placment is by cxr and then the above check is done q8hr.

LilRedRN1973 · Sep 27, 2003

We just did this in school and whoopee!!! I know the answer to something...teehee. In our class, we are taught to check for placement by aspiration. Put in 30cc of air into NG tube then draw back until liquid is drawn into syringe. Check for proper pH using litmus strips. If no liquid, reposition patient on left side and repeat procedure above. Still no liquid, reposition pt. on rt. side and repeat. Also, you can check by putting air into NG tube and listening with steth over the stomach. Not sure if this differs from school to school or facility to facility.

Zee_RN, BSN, RN · Sep 27, 2003

Originally posted by batmik
If it is for suction we just listen with stethoscope over epigastric area after instillation of air, also check fluid suctioned out. If it is for feeding the initial placment is by cxr and then the above check is done q8hr.

Same policy here.

AmiK25 · Oct 1, 2003

We check our NG/OG tubes with auscultation by two separate RNs. If it is for feeding/medications, we also get a CXR after insertion. Then, we re-check placement with every assessment which is q 4 hours.

nursenatalie, ADN, RN · Dec 31, 2003

Unfortunately most of the time I put down an NG tube I immediately receive 1800cc return...no need to check that! I do subsequently check placement by air!

IamRN · Jan 1, 2004

Check per air bolus/aspiration...and if the pt has AM xry I check there too. I check placement w/the q4h assessment.

gwenith, BSN, RN · Jan 1, 2004

Lit search I did suggested that correct placement by auscultation of air sounds was not accurate - and since many pts are on continuous feeds +/- gastric ulcer prophylaxis the PH may not be acidic.