NG tube placement

Specialties NICU

Published

I am in the process of doing research to find guidelines for NG tube placement in preemies but I am realizing there is really not much literature out there...How do you determine placement and does your unit use evidence based practice to support the way it is verified...thanks!

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Measure nose to ear, ear to xiphoid process.

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Specializes in L&D, OBED, NICU, Lactation.

Evidence shows that the nose to ear, ear to xiphoid is not as reliable as NICU nurses would like to think, nor is nose to ear, ear to umbilicus or xiphoid-umbi midpoint.

de Boer, J. (Coby), Smit, B. J., & Mainous, R. O. (2009). Nasogastric Tube Position and Intragastric Air Collection in a Neonatal Intensive Care Population. Advances in Neonatal Care, 9(6). Retrieved from Nasogastric Tube Position and Intragastric Air Collection in... : Advances in Neonatal Care

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We verify placement the same way you would in an adult. We either check for stomach content, or auscultate. I don't know what more you need to verify placement. I learned this in nursing school. We were also taught that you could check the pH, but we don't do that.

As for depth, we use the different methods mentioned above. I don't think all nurses measure the same. Occasionally after a baby has had an Xray the docs may write to advance or pull back the OG/NG by so many cm.

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Our NICU is changing to no longer using auscultation as a way to check placement evidence based practice is showing that it is not accurate way to verify. We will be checking by aspirating and testing the pH or X-ray. This will be a big change and should be interesting. No way we can get an X-ray q3-4 hours before our feedings.

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Specializes in Nurse Scientist-Research.

The NICU where I work still uses auscultation and aspiration knowing that one does not always get an aspirate. I recently did school assignment (please someone tell me this BSN is worth the torment!) that addressed the evidence on how to verify enteral feeding tube placement. In 2009, the American Society for Parenteral and Enteral Nutrition (ASPEN) issued guidelines that state that all enteral feeding tubes should be verified by xray, all other methods have been proven to be unreliable (aspiration, auscultation, pH testing). Probably in response to these guidelines, the American Society of Critical-Care Nurses issued a practice alert recommending x-ray verification for all blindly inserted feeding tubes.

The AACN did not specifically address pediatric/neonatal patients. A.S.P.E.N. stated that x-ray is the only reliable way to verify placement in the pediatric and neonatal population but that due to the risk of exposure to x-ray, they should be used "judiciously" in verifying enteral tube placement in this special population.

American Society of Critical-Care Nurses. Verification of feeding tube placement (blindly inserted). Aliso Viejo, CA: 2009. AACN practice alert: http://www.aacn.org/WD/Practice/Docs/PracticeAlerts/Verification_of_Feeding_Tube_Placement_05-2005.pdf

Bankhead, R., Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., Matheney, A., Mueller, C., Robbins, S., Wessel, J. & the A.S.P.E.N. Board of Directors (2009). A.S.P.E.N. Enteral nutrition practice recommendation. Journal of Parenteral and Enteral Nutrition, 33(2), 122-167.

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Specializes in NICU, PICU, PACU.

You can't get an X-ray before all feeds! Those kids would light up after a day! We still do auscultation or aspirate. I can see getting on n the initial placement and making sure the mark is noted.

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We x-ray to confirm placement following tube insertion (or if the tube has moved).

We aspirate prior to every feed (or 6th hourly if on continuous feeds) and test pH. We accept a pH of 1-4 if on bolus feeds, or 1-6 if on continuous feeds or PPIs.

We do not use auscultation. The reason being the air injected could as easily be heard in the lungs with your stethoscope as it could in the stomach.

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Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

We measure carefully as another poster described, note tube marking and auscultate and aspirate before every feeding and q4 hrs with continuous feedings. Tube placement is noted on X-rays taken for other reasons, but we do not routinely get X-ray verification just for an NG/OG tube.

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I remember learning in nursing school that if the tube was actually in their lungs you would still hear the sound. But when I listen, and I'm pretty sure when everyone else listens, I can tell that the sound is coming from right below where my stethoscope is placed. I'm assuming that if I was listening and the tube was in their lungs, it would sound a little different. This has actually never happened to me, but it did happen to a nurse a few weeks ago, and she could tell that it didn't sound right.

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