PEG tube placement checks

[IngyRN]

Hi All,

At my hospital, RN's check placement of PEG by inserting 30cc of air and listening w/stethoscope. Is this common practice?

I thought this technique was done to check placement of NGT since it could dislodge. I was under the impression that PEG tube placement was checked by aspirating stomach contents and checking pH.

Can anyone offer any insight? Thanks!

[TiffyRN, BSN, PhD]

A PEG tube CAN displace but the chances of it happening compared to an NG are tiny. I have never auscultated air for PEG placement nor seen anybody do that. In fact when I worked with adults we never checked placement of a PEG. Sounds like a good idea though; but with pH or contents, not auscultation.

[txspadequeenRN, BSN, RN]

i work geri residents and alot of them have pegs but, i always check with aspiration and and then auscultation upon putting the fluids back in. i have never checked the ph and pretty much see that as a unnecessary procedure... not to mention what a potential mess you would have....

[psalm, RN]

We insert the air and listen for the gurgling, then check for residual.

[morte, LPN, LVN]

ok...assuming the peg is in the stomache to begin with....were is it going to go? unless it perfs the stomache wall the only place it would go is the small intestine....making auscaltation a moot point....and is the reason for using the pH testing.....auscultation is helpful, of course, for NG tubes....

[DDRN4me]

Gastrostomy tubes can migrate; can obstruct sphincter of Odi; or go into small intestine or coil up into esophagus. I usually aspirate for resdual; and if questionable, will test ph. if done properly it doesnt have to be messy.

[fultzymom]

We ascultate for placement et then we verify by aspiration. That is our policy.

[kittagirl]

In UK standard policy to check for NG placement is via x-ray only. And the x-ray must be checked by a senior doc before feeding takes place. Once in it should be marked and if any movement noted re:xray before continuing.

Very time consuming, but policy has been dictated by the Dept of Health. There have been several cases where tubes have been sited incorrectly but still got a +ve sound and pH test.

So if they're been fed for any lenght of time we go towards PEG, they once inital post placement check are just checked via aspiration and pH paper

[KellieNurse06]

I was taught to check placement for ng tubes with pushing air in..or placing the end of the tube in a glass of water.....if it bubbles it is a good chance it's not in the stomach. The ones we check for migration are the regular gtubes..the ones that are like foley cathethers...yes thos can migrate up or down....and we check by a mark on the tube to verify it's still the same length.

The one that kills me is when people check for placement on a button......ummm the thing is only an inch or two long & isn't going anywhere.....lol......

[morte, LPN, LVN]

hmmm in almost 21 years i havent seen one go UP, nor have i heard of one.....

[Ariesbsn]

I was told that we didn't have to check a PEG for placement.

As far as NGT placement goes, even if you auscultate AND aspirate, it doesn't always mean proper placement. I had been off orientation less than a month. The on call internist for the ICU intubated one of my pts and placed an NGT on a pt that wasn't obese. I listened while he delivered the air bolus.

ME: Could you do that again? I didn't hear anything.

Bolus was repeated.

ME: Boy, what I heard was really faint and didn't sound like it normally does when I do this.

DOC: It doesn't matter what you heard, I just aspirated stomach contents and that is the definitive sign that you are in the stomach.

In the morning, I told the nurse that relieved me about what happened. He pulled up the x-ray that was done to confirm ETT placement. The NGT had gone into the pts stomach, curled in the stomach, come back out, and the tip was resting near the right main stem bronchus.

About a month ago, I had a pt that was vented, sedated, obese, and had an OG. I did my checks and it sounded like it was placed. She had what looked like stomach contents coming out of the OG. The morning x-ray showed that the end of the OG was in the pts esophagus.

I have yet to find an institution in my city that uses pH strips.

[kittagirl]

Scarey stuff........................