NGT and PEG placement verification

AmericanChai · Nov 15, 2007

I'm sure the professionals can answer more what you are looking for . .

as a parent (not nurse yet) of a child who has had both types of tubes, this is what I was told by hospital staff:

1) NG tube: I was given a stethoscope and was told to push a little air into the tube and listen for the "burp" in her stomach before feeding her. A less accurate way is to draw out stomach contents and see if anything comes out before feeding. The problem is that if the stomach is empty this won't work. It also won't tell you if it's migrated somewhere else within GI tract. If you have a child who has GERD it could be that you are drawing from the esophagus instead of the stomach. My child has had her g-tube for more than 3 years and I've never checked it for placement before feeding.

2) With a peg tube I was not given any instructions to check placement after she was discharged with her new tube. I was told that if it had redness coming out more than 1 inch, or redness that grew, or discharge with an odor, to call the doctor as it might be infected. Normal discharge was okay (greenish even) as it's part of the healing process.

flightnurse2b, LPN · Nov 15, 2007

PEG tube: use a 60cc syringe and aspirate gastric contents. residual should be yellow or greenish... and should be less than (check your facility policy though) 150cc. replace gastric contents into stomach and i like to ausculate at the same time. if residual is greater than 150cc, hold the feeding. then flush with 30cc of h20 or whatever is ordered by the MD. NGT: typically placement is checked originally with x-ray. use a 60cc syringe and inject 20cc of air. listen for "swoosh" sound in the xiphoid area. then aspirate gastric contents.. residual should be yellow or greenish and less than 150cc if any at all. test pH with dipstick if ordered and replace residual.

MesaRN · Nov 15, 2007

Evidenced based practice has shown that the traditional pushing air into the tube and listening is not accurate. The best practice is initial verification with an x-ray followed by testing contents for pH. The facility I work at has explicitly banned the use of the "air test". They say that bowl sounds may be heard and mistaken as the sound of a good placement.

DN08 · Oct 8, 2008

I have a pt rite now that has a PEG, is it necessary for them to get a x-ray every day? My pt doesnt but i thought they were recomended to, but of course I may just be getting this confused with a NG tube... *still a student. AND have you seen the feeding infusions that you can set to do a flush, basically with y tubing. I was told not to flush the peg after giving medicine because the machine would automatically do it? any thoughts?

pielęgniarka, RN · Oct 8, 2008

I have a pt rite now that has a PEG, is it necessary for them to get a x-ray every day? My pt doesnt but i thought they were recomended to, but of course I may just be getting this confused with a NG tube... *still a student. AND have you seen the feeding infusions that you can set to do a flush, basically with y tubing. I was told not to flush the peg after giving medicine because the machine would automatically do it? any thoughts?

PEGs don't get an X ray every day. Currently the protocol I know of is to confirm all gastric tubes with auscultation of air and then aspiration of contents. At the places I've worked at we still give 60cc h20 flush before and after medications regardless if they are on continuous fdgs or not. The pt needs to have that water.

southernbeegirl, BSN, RN · Oct 13, 2008

does anyone have any information on this topic?

we had a patient with a dobb hoff that pulled it out. one of the LPNs called the DON at home and she told her to replace it with an NGT and that she didntneed an xray to confirm placement.

i'm trying to show her how that is not the way to confirm placement anymore. i also suck at searching, lol

abelm · Feb 4, 2011

This is a frequent question that comes up when we teach Enteral Feedings. The text that we use "Fundamentals of Nursing" 2nd ed Wilkinson & Treas states on pg 640 "NG and NE feeding tubes are placed without direct visualization. As a result, there is risk of placing the tube into the respiratory tract. Therefore, you must check the location of the tip of the feeding tube before each enteral feeding or once per shift for continuous feedings". They go on to address the bedside methods one might use. They do not address G-tubes and one might assume then that G-tubes do not require verification of placement on an ongoing basis (when place by the physician, placement is verified). The old saying was "if it isn't in the stomach, it is in the bed".

I have heard anecdotal reports of g-tubes migrating out such that the feeding is trying to infuse into sub-Q tissue. It seems to me that inspection prior to a feeding & routinely (q8h), would alert one that something is wrong - redness, drainage, edema at the site. As for any tube feeding you need to check residual (before a feeding or q8h) this would support (or place in question) if the tube was in place. Further, it seems that if you were to woosh 20 - 30 ml of air into the sub-Q tissue, this would only further damage tissue.

Open to any other thoughts!

steelydanfan · Feb 5, 2011

Evidenced based practice has shown that the traditional pushing air into the tube and listening is not accurate. The best practice is initial verification with an x-ray followed by testing contents for pH. The facility I work at has explicitly banned the use of the "air test". They say that bowl sounds may be heard and mistaken as the sound of a good placement.

Well, as someone who has been doing this for 30 years, I CAN tell you that the "whoosh" of air sounds NOTHING like bowel sounds, it's pretty darn specific.

However, most hospitals require an x-ray, and that's the gold standard.

An x-ray followed by ph testing is overkill, IMHO

OgopogoLPN, LPN, RN · Feb 5, 2011

My hospital requires an x-ray post NG tube placement. Not 100% sure about PEG tube.

Biffbradford · Feb 5, 2011

In the last hospital I worked at, all NGs had to be verified by CXR before use. We would sink it, verify by auscultation (burp test), get the xray, then pull the stylet and begin the feeding. For a while, we weren't even allowed to use them unless they were placed post pyloric for fear of aspiration. That got a little overboard because on some patients, the only way we were getting that done, because of their anatomy, was at interventional radiology which meant another road trip in the bed (major pain). Half the time the patient was confused enough that they'd pull it out and have to go through that again (and again). I did see a couple new nurses take short cuts and start the tube feeding before they got the Xray verification and ended up filling half a lung with Nepro. NOT GOOD! :lol2:

steelydanfan · Feb 5, 2011

In the last hospital I worked at, all NGs had to be verified by CXR before use. We would sink it, verify by auscultation (burp test), get the xray, then pull the stylet and begin the feeding. For a while, we weren't even allowed to use them unless they were placed post pyloric for fear of aspiration. That got a little overboard because on some patients, the only way we were getting that done, because of their anatomy, was at interventional radiology which meant another road trip in the bed (major pain). Half the time the patient was confused enough that they'd pull it out and have to go through that again (and again). I did see a couple new nurses take short cuts and start the tube feeding before they got the Xray verification and ended up filling half a lung with Nepro. NOT GOOD!

You are talking about Keofeed tubes here, not NG tubes. All Keofeeds require an xray to confirm placement before feedings can commence.