pH in NGTs

[arabas]

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!

[JBMmom, MSN, NP]

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.

[LovingLife123]

We only get a KUB if we are going to give meds through it. If it’s just for decompression we use air injection.

[LovingLife123]

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.

[Quota, BSN, RN]

NG tubes are confirmed by X-ray after placement.

[MunoRN, RN]

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

[mmc51264, BSN, MSN, RN]

X-ray at my facility

[JadedCPN, BSN, RN]

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.

[AceOfHearts<3]

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.

[Here.I.Stand, BSN, RN]

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

[Butterfly]

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

[L-ICURN, BSN, RN]

Confirmed by xray.