How do you verify NG tube placement on your unit?

MiniBabyRN · Mar 23, 2012

We auscultate air as well and check for aspirates. However, there are plenty of times when the baby gets an x ray and the NNPs will call us with orders to advance/pull back by x cm.

countessyana · Mar 25, 2012

well, we acctually measure the distance between preemie's stomach to his ear and mouth....that's pretty 'on the spot'...and ofcourse verify it by the other methods you mentioned. we never use X-ray for NG tube insertin...

dixRN · Mar 27, 2012

I have worked nine NICUs all over the country & all of them checked for NG/OG placement by aspirating for stomach contents & by listening for air "bubbling" with stethoscope when air injected via NG/OG. ND & NJ tubes required xray verification after placement.

turnforthenurse, MSN, NP · Mar 27, 2012

We do placement check via auscultation with air bolus. When tube is initially placed, we do that and then verify placement via x-ray. After that, it's auscultation and checking for residuals Q4H.

Bortaz, MSN, RN · Mar 28, 2012

I'm pretty surprised at how many nicus bombard the kids with X-ray radiation just to check ogt placement.

NICU<3RN · Mar 28, 2012

I'm pretty surprised at how many nicus bombard the kids with X-ray radiation just to check ogt placement.

I am also surprised. Especially that its fairly often a kid will pull their tube out.. I've also heard (but not seen) that some NICUs reinsert the NG for each feeding in order to prevent reflux (sphincter is always open with NG tube.. and if in long enough the muscles may not form strong enough to keep it closed once the tube is removed).. that would be a lot of xrays/ radiation for a tiny baby..

canned_bread · Mar 30, 2012

At our NICU we place, auscilate, pH. After that prior to commencing feeds or putting down any meds we x-ray. This is hospital policy.

babyNP., APRN · Mar 30, 2012

My institution is heavily considering going hospital-wide on checking pH paper for NGT placement. Needless to say, the NICU is not happy... Question for that do the pH paper--do you like it? I just feel like it would be more ineffective because we have tons of kids on anti-reflux meds and some kids without residuals (there is talk to putting in sterile water into the gastric area just to pull it out again :eek: )

Bortaz, MSN, RN · Mar 30, 2012

babyRN. , i hope we don't start that at our NICU.

wooh, BSN, RN · Mar 30, 2012

At our NICU we place, auscilate, pH. After that prior to commencing feeds or putting down any meds we x-ray. This is hospital policy.

Goodness, why not just put the babies in a microwave for a few minutes and be done with it?

My institution is heavily considering going hospital-wide on checking pH paper for NGT placement. Needless to say, the NICU is not happy... Question for that do the pH paper--do you like it? I just feel like it would be more ineffective because we have tons of kids on anti-reflux meds and some kids without residuals (there is talk to putting in sterile water into the gastric area just to pull it out again )

pH paper is RIDICULOUS. Completely ignores the fact that most NGTs are getting GER meds. The whole argument of, "It could be in their lung and you'd still hear the air bubble," is stupid, because if it's in their lung, they'll be coughing. If it's a patient that for whatever reason wouldn't show other symptoms in their lung, THEN sure, go for other placement checks to be sure. But once again, why use critical thinking and treat each patient as an individual when we can come up with stupid hospital wide policies?

Bortaz, MSN, RN · Mar 30, 2012

Five stars for wooh!

babyNP., APRN · Mar 31, 2012

One of our educators is doing a mini-trial on the unit to see if it actually works...I really hope our chief doctor can put a stop to it, but apparently it's a hospital-wide thing and may be beyond our chief's control. Because...yeah, the kid would immediately start coughing and decompensating! No matter how small you get the NGT, it is still big enough that it is going irritate their lung tract. I suppose you could make a case for a paralyzed kid on vecuronium or the comatose kids, but the former we wouldn't be feeding at all anyway. Comatose, okay I grant you that is a higher risk. Most of them have g-tubes anyway, though.