NG Tube how to measure?

[Wheaties]

Okay, I'm a little conflicted.

1) Measuring NGT from the tip of the nose, to the earlobe to the end of the xiphoid process

2) Measuring NGT from the tip of the nose, to the earlobe, to the point between/halfway xiphoid process and umblicus (belly button)

which is the proper way? i googled it, most said, measure up to the xiphoid process. another said between the xiphoid and bellybutton? which is right?

[Kuriin, BSN, RN]

It's the first one. If you want to do a nasojujenum tube, then you're going to go past the xiphoid process.

[chare]

With the 6th edition revisions, NRP recommends measuring using the method you list second. When you consider diaphragm positiong and movement during the respiratory cycle it makes sense,

[ladysyrah]

Sounds like, from chare's post that both have been considered measurements. Now, I am currently in nursing school and was taught the first method mentioned (to the xiphoid process). If this question is in regards to your program, I would recommend talking to your teacher to discuss that you found there are two ways of measurement, discuss what they are, then ask when it comes to their curriculum which do they want you to use (unless it is in your book, then go by your book's description). This will show that you have the information, you aren't asking them to tell you the answer you are coming to them with two possibilities of answers that are both correct and clarifying what they want. This will help you appear informed but wanting to learn and be accurate. It would be hard to say which one is most accurate as they need to teach what are in the books/on the NCLEX so most likely it will still be the first method for testing reasons but can open the floor for an interesting conversation with your teacher.

[Wheaties]

i went back to my old nursing skills checklist, it says measure up to the xiphoid process. but it's interesting. i googled it, and i figure i'd post about it here. any students here should ask the teacher though for clarification just like the above post suggested, and tell me your findings.

[chare]

• Predicting the Insertion Length for Gastric Tube Placement in Neonates
  
• Predicting internal distance to the stomach for positioning nasogastric and orogastric feeding tubes in children
  
• Verifying NG feeding tube placement in pediatric patients
  
• Nasogastric Tube Placement and Verification in Children: Review of the Current Literature
  
• Potential Risk of Malposition of Nasogastric Tube Using Nose-Ear-Xiphoid Measurement
  
• Methods to determine the internal length of nasogastric feeding tubes: An integrative review
  
• Nasogastric tube depth: the ‘NEX' guideline is incorrect
  

[AliNajaCat]

Either one is a good place to start, but what's more important is to check the placement before you put one drip of anything down it, and to keep it draining and venting appropriately (if it's a Salem sump). Here's an old post that explains it very well.

before salem sump tubes were invented, all we had were single-lumen tubes to suck out stomach contents. what's the problem there, you say? well, if suction has removed all liquid stomach contents and it keeps sucking, what you get are little punch biopsies of the stomach mucosa, and this is not a good thing. so, some clever person (perhaps a salem witch) figured out that if there were a way for the suction to have something else to suck on, to break the vacuum in the stomach, like air (and any other fluid that happened to accumulate too, of course), then this would protect the stomach from having vicious little hickies from suction at the eyelets down below and bleeding and such.

the air vent on the salem sump is that solution. air should always be going down the blue lumen. how do you know if that's happening? well, you can put your ear near it and hear it, or put your thumb over the end of it briefly and feel suction there, but the best way to see is that there should always, always, always be air bubbles coming up the main lumen to your suction cannister. now you know something important: if it isn't, there's hickifying going on down there, and that's a bad thing.

the air vent lumen should always be patent (open) all the way down. if it isn't you can do a couple of things (after you have determined that some fool has not turned off your suction outlet). one is to untape the tube and pull it back an inch or so, and then put it back. you can also push some air (not fluid) down the blue lumen. yes, you may have to do this all dang day long, but you will often be rewarded by a gush of gastric goo, which is what you wanted anyway.

what's going on if there is no air coming up the main lumen and there's goo coming out of the air vent? well, (assuming your suction is still turned on and plugged in properly) your main lumen is probably occluded and goo has nowhere else to go but up the air vent, and you should probably think about replacing the whole tube. but before you do that, if it's not otherwise contraindicated, shoot some ns down both lumens, and follow that with air down the air vent lumen. see if that doesn't get things moving properly. if not, do the wiggling thing as above. if that doesn't work, get the ok to replace it (or have the physician or np come and replace it).

some salem sumps come with little plugs in the blue lumen. they're supposed to allow air entry and prevent backflow but they don't always really do a great job of it. if you can still verify air entry past that plug and bubbles are going up the main lumen, it's fine. but if it's gotten grubby and acts like an actual plug, get rid of it, or what you have is now a gastric mucosa-grabbing single-lumen tube.