checking NG tube placement

[Lorus]

What is the standard in your unit for routine checks of NG tube placement? Checking characteristics of aspirate? PH? Insufflation and auscultation?

[kc ccurn]

It if is an NG tube, we check placement with air bolus auscultated over epigastric region and assess q shift, and as needed. If it is a dobhoff feeding tube (smaller, more flexible) our goal is to place the dobhoff into the duodnum. for dobhoff's we check with air bolus in RUQ and get a KUB for placment before we start tube feedings. We generally try to not use NG's for tube feedings since they are so big, we will put down a dobhoff then.

[skemergirl]

In the Peds ICU we check ng for placement after insertion by small air bolus over eipgastric region then aspiration of the air and gastric content, then q shift and before meds and starting feeds. If insertion with intubation, check w/ xray.

[hollyster]

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

We x-ray for placement. Ausculatation/aspiration and placing tube into a cup of water to check for air.

[KimberRN1]

We check by auscultation when first placed..then we're required to have an xray to confirm it, and before tube feeds...

[dgudmestad]

NGT's are not used for feeds at our place and we get a KUB after placement. We use dobbhoffs for feeds (they get a KUB also) only. I work at a university hospital where an aspiration study took place and the incidence for aspiration with tubes other than dobbhoffs is extremely high. HOB always at 30 degrees or better.

What is the standard in your unit for routine checks of NG tube placement? Checking characteristics of aspirate? PH? Insufflation and auscultation?

[rankin172]

Ausculation of air is unreliable as you can hear the gush of air even if the tube is in the respiratory tract. The safest way is CXR failing that pH strip.

[tri-rn]

KUB on initial placement, no matter what it's being placed for. You never know when the team is going to want to start TF. Check for placement with air bolus/aspiration Q8H. We use Salems for decompression but kaofeeds (I think similar to a Dobhoff?) for TF, and we generally try to place those post-pyloric.

Incidentally, this is a new-ish policy. A lot of our more experienced nurses were still doing it strictly by air bolus on placement. Not long ago I helped an orientee place a kaofeed, we both listened, and heard the air. KUB/CXR showed the kaofeed squarely in the lung (I think it was the left). I don't trust air boluses, and I will get a KUB if I have even a hint that the tube may have migrated.

[RN Joe 86]

Listen for the burp, initially. And, of course, a CXR.

[ZippyGBR, BSN, RN]

aspiration of stomach content and/or Xray

insufflation is NOT a definitive check

[TemperStripe]

Interesting tidbit...

Had a Pt post-esophagectomy, something like POD 56. NG tube was sutured in place, draining, etc...however, I was not able to auscultate air, presumably because of the new placement of his stomach relative to his esophagectomy.

[mcneillmama3, BSN, RN]

I'm not certain where everyone is getting "if it is for suction do this, if it is for feeding do this." I think you should check placement using both aspiration and inject air/auscultate no matter what. You don't want the NG Tube migrating in to the lungs no matter what the purpose of the tube is. Also, look in the back of the throat with a pen light to check for kinking. Sometimes, no matter what you do, you won't withdraw any stomach contents since some patients may have really quick gastric emptying or are NPO and their stomach would be empty anyway. Regarding nursing homes where many residents have NG Tubes and also in the home health setting, you aren't going to be checking placement with a CXR. More than one check is needed to confirm placement.

I also had a veteran nurse show me this trick. She would take the end of the tube and place it in a little bit of water. If you see bubbles in the water when the patient exhales, then the tube has migrated in to the trachea or lungs.

Also note where the marks are on the tube in relation to the clients nose and see if the mark has moved since the last time you checked. (Just like you would for a patient with a ET tube)

I had a hospital patient once, and every time we tried to put the tube down, he was pushing it right back out with his tongue as fast as we could put it down.. WE almost never got the NG Tube in him!

[TangoLima]

What is insufflation, and how would one do it?