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pH in NGTs

Nurses   (359 Views 12 Comments)
by arabas arabas (New Member) New Member Student

69 Profile Views; 1 Post

I was directed to pose this question to all nurses. What is your hospital policy regarding nasogastic tube placement confirmation? Does anyone or has anyone check pH via strips or is x ray the gold standard? Thank you!

 

 

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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

1 Follower; 834 Posts; 11,857 Profile Views

We always confirm placement with x-ray. Then for my Q shift assessment I will use audible air injection always and aspirate pH sometimes (I admit on busy nights that I can't find the pH paper I sometimes skip it, very few of my colleagues do it). Especially for patients with tube feeds, or those that are restless, ensuring continued proper placement is important.

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1,063 Posts; 7,457 Profile Views

We also don’t use NGs to feed.  We put feeding tubes in the small bowel.  Those are verified with our placement machine, gold aspirate, and by sound.  You need two verifiers.

 

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Quota is a BSN, RN and specializes in Oncology.

1 Follower; 293 Posts; 3,675 Profile Views

NG tubes are confirmed by X-ray after placement. 

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

6,289 Posts; 64,943 Profile Views

Auscultation and pH have been shown to be of limited value in confirming placement of enteral tubes, Xray is the common standard.  

 

 

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mmc51264 has 7 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

2,685 Posts; 38,710 Profile Views

X-ray at my facility

 

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JadedCPN has 13 years experience as a BSN, RN and specializes in Pediatrics, Pediatric Float, PICU, NICU.

1 Follower; 748 Posts; 7,444 Profile Views

In the past two pediatric hospital I have worked at, they both have tried to stay away from Xray use for confirmation as much as possible to limit the radiation exposure to the pediatric patients. Especially in the NICU population where the skin is so delicate that you have to be extremely careful and stingy with how you secure your tube - it is pretty common for NG tubes in the feeder/grower population to come out or at least partially out once a shift, so the idea of xraying them every single time we replace that NG is a bit much.

Neither hospital used auscultation as a reliable source of confirmation. At my current facility, you can confirm placement by measuring appropriately per protocol, observing the color of the NG tube aspirate contents, and having a pH of 5 or less. In rare instances do we actually use XR to confirm placement.

Edited by JadedCPN

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AceOfHearts<3 specializes in Critical care.

884 Posts; 14,405 Profile Views

We use X-ray to confirm placement and we always chart how far it is advanced-such as right nare at 60. We then assess aspirate characteristics and that the tube is in the proper spot by the measurements.

If the NG tube is for gastric decompression and it’s an emergency then we’ll go off aspirate characteristics. I’ve placed an NG tube for decompression and before I could even hook it up to suction it has had gastric contents backing up into it. Cases like that the risk of the patient vomiting and aspirating is so high that we’ll hook it up to suctioned without X-ray confirmation. 

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Here.I.Stand has 16 years experience as a BSN, RN and specializes in SICU, trauma, neuro.

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We just verify by aspirate characteristics.  Feeding tubes are placed in the jejunum and are verified by xray

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Butterfly specializes in Nephrology.

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If u use small tube like dobhoff tube or u need to place it to jejunum it need x ray but if it is only a Salem tube just verify it by checking for gastric conteny or by instilling of air n listening with d stethoscope

 

 

 

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L-ICURN has 7 years experience as a BSN, RN and specializes in ICU.

87 Posts; 933 Profile Views

Confirmed by xray.

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