confirming NG placement

[bennyboy]

Hello--I am new to this site so take it easy on me. Does anyone out there use pH testing of gastric contents to confirm NG placement. What if you know it is in the stomach but you pH is too high? Does your policy state to check again in an hour? Does it state you can hook up to suction? Thanks for the input!!!

[followurdreams]

Hi, I am a nursing student and my skills book does say that after X-ray, PH testing is the next step to verifying placement. However, the institutions where I do my clinicals do not use PH testing. Instead, after aspirating (or trying to aspirate) up to 30 ml of gastric secretions and returning it back into the stomach, you then draw 30 ml of air into the syringe, auscultate in the left upper quad of the stomach and quickly push the 30 mL in. You will hear a pronounced gurgling sound if you are in the stomach. I was able to do this last week.

Hope it helps.

[kaliRN]

Originally posted by bennyboy

"What if you know it is in the stomach but you pH is too high?"

Could you clarify how you know it is in the stomach if the pH is too high?

[bennyboy]

I was the one who developed the policy and it has been going well in our inpatient units but not in the ER. One occurence recently was:

A Small Bowel Obstruction, NG placed, sucked 1500ml of fluid out and the pH is higher due to it originating in the bowel. They knew it wass in because of the amount of fluid, but the pH is too high. My policy states that confirmation will be made by pH only, and radiography can be sought if placement is still in question. Do you think there can be something added, like waiting a certain amount of time and rechecking?

[Slobgob]

Wow. Never knew this was such an issue. pH?

If green stuff comes out... its good. No need X-ray for placement in you're decompressing... but I suppose we get one before we start meds/feeding.

Though... maybe we're just behind the times.

[mn_nurse]

It is best practice to only rely on radiographic evidence. I have seen some facilities rely on pH of aspirate. This is probably to save money, and if the NG will only be used to aspirate stomach contents and then be removed, the need for radiographic proof is diminished.

Here is the link for NG tube placement:

http://www.aacn.org/WD/Practice/Docs/PracticeAlerts/Verification_of_Feeding_Tube_Placement_05-2005.pdf

[Miss Kitty00]

wow. never knew this was such an issue. ph?

if green stuff comes out... its good. no need x-ray for placement in you're decompressing... but i suppose we get one before we start meds/feeding.

though... maybe we're just behind the times.

that's how we do it at my facility.

[bill4745, RN]

All we do in our ED is listen for air bubbles when we inject air and look at the color and amount of aspirate.

[netglow, ASN, RN]

"and the pH is higher due to it originating in the bowel"

Say what?

[chevyv, BSN, RN]

At school we had to check the ph strip to the bottle. I've never seen anyone do it besides students though.

[CABG patch kid, BSN, RN]

"and the pH is higher due to it originating in the bowel"

Say what?

I think he meant the pH was higher in that particular case because the tube had been advanced all the way down to the duodenum, where it would be alkalotic, not acidotic. Maybe I misunderstood?

[gradcare, LPN]

Also it must be remembered that many medications used to prevent stomache ulcers including H2 blockers can alter the pH in the stomache so pH testing can be unreliable (false negatives) additionally listenting and pH testing do not give you a reliable provable placement for the tip. Radiographic proof is probably the best way to ensure correct placement for feeding and meds particularly since some fine bore NG tubes can collapse if aspirated.