Do you auscultate your NGs?

[Carpediem1012]

I am just wondering how many here auscultate to check tube placement in their patients with nasogastric tubes meant for feeding or med administration. If not, how do you verify placement in the stomach? (And this is not a homework question haha). I have recently written a paper on the topic and wonder who is using each method.

[Carpediem1012, BSN, RN]

Will do. :) thanks!

[wanderlust99]

My last facility I worked at, would only use dobhoff tubes, that must be inserted with a cortrack and you had to have radiology confirmation before using. Large bore NGTS were only seen after surgeries (and were placed by the physician in OR)...not for feeding or meds.

I have never worked in a hospital that checks pH for placement, or ever seen it done!

[vanilla bean]

In my program, the instructors stressed that auscultation was not EBP and that pH testing should be used for ongoing placement checks (Xray after initial placement). However, we were still taught how to auscultate (not test for pH). In every clinical placement, I only ever saw, and was instructed to perform, auscultation (never once seeing pH testing). This is also true of the facility for which I currently work - no pH testing, just auscultation.

[AJJKRN]

My last facility I worked at, would only use dobhoff tubes, that must be inserted with a cortrack and you had to have radiology confirmation before using. Large bore NGTS were only seen after surgeries (and were placed by the physician in OR)...not for feeding or meds.

I have never worked in a hospital that checks pH for placement, or ever seen it done!

To the best of my knowledge a Dobhoff should not be "aspirated" because the lumen is so pliable that it just collapses anyways so you wouldn't get any aspirate out to be able to check a pH on so X-ray confirmation with the guide wire left in to be advanced/reinserted if needed is the way to go. Same concept with not aspirating a j-tube.

[Here.I.Stand, BSN, RN]

Our NG/OGs are always to suction (usually low continuous); we confirm placement w/ aspirate of gastric secretions. For feedings, pt gets a Corpak (NJ). X-ray is used to confirm a post-pyloric placement prior to start of feedings.

[Red Kryptonite]

In my program, the instructors stressed that auscultation was not EBP and that pH testing should be used for ongoing placement checks (Xray after initial placement).

This is what we are currently being taught in my class.

[zmansc, ASN, RN]

I put one down a pt in distress due to bowel obstruction one day, got 150cc of brown fluid out, we were certain we had it in the stomach until the O2sat dropped from mid 80s to low 60s, then we realized we were in the lungs, pulled it out, re-tubed, this time in the stomach and pulled out about 1700cc before they took her to OR.... It was still pulling out alot too! She had been backing up for quite a while I guess.

As a side note, she was one of the most combative patients I've ever dealt with during all that, took four nurses to keep her alive until she got to OR. She came into the ER about two months post and I took care of her again that time too. She was as nice as could be. I asked if she remembered me and told her I took care of her that day. She told me she had no recollection from going to bed the night before until she woke up in the ICU. We had a good talk and laugh, and she thanks all of us for saving her life that day. It really helped me to realize how often our patients might be acting in one way but feel totally different in the long run and why.

As for confirming placement when we drop an NG in our ED, we will auscultate at a minimum. If it's going to be used for putting stuff in, stay in a long time, and we have time (non-emergent) we will order a film.

[nrsang97, BSN, RN]

When we order a NGT for feeding/meds/suction, EPIC prompts us to order a chest x-ray for confirmation. We are supposed to use the CO2 detectors but I don't trust them either.

[Esme12, ASN, BSN, RN]

I auscultated a dobhoff last week, heard bubbling in the stomach, and the X-ray said it was in the right lung base. Oops!

So no, I tend not to trust auscultation either...

In facilities that allow Dobhoff tube insertion by the RN a CXR has always been the standard for placement. The tube is small and doesn't produce enough of an "air" sound.

[Esme12, ASN, BSN, RN]

In facilities (non-academic) that I have worked auscultation has always been accepted and return/testing of gastric contents. A physician order was necessary for the CXR.

In the ER we drop and listen...some times the pH will be tested but not always. It is of note that this is slowly changing in all practice areas to go with a CXR as standard

[~PedsRN~, BSN, RN]

We listen. If we are putting something down the tube, we get imaging studies. If we are putting the thing to suction, for a bowel obstruction, etc - then we don't unless it quits pulling out crap and we can't figure out why. It's hard to not be able to confirm placement when one is to suction. It's either draining out ick or it's not. :) And of course if it's something like an ND placement, it is always checked with imaging.

[mariebailey, MSN, RN]

We always confirm placement with a KUB initially. I auscultate during morning assessment in addition to checking for residuals. For the rest of the shift, I just check for residuals and check what cm mark it is at in the nare. This is how I was taught.