Placement if ND tube

[rnpete]

Other than Xray, how do you check placement of an end tube?

[NotReady4PrimeTime, RN]

We aspirate for stomach contents at the gastric mark before advancing. When the tube is at or beyond the jejunal mark we aspirate again, looking for a "snap" and for movement of the tube. Typically, if the tube hasn't crossed the pylorus, it will move with respirations and will slip out a little with each breath. If the tube has a snap and isn't moving, then we insufflate with a few mL of air, listening first over the epigastrium and then at the right mid-axillary line just above the costal margin. There should be a loudly audible gurgle in both spots. THEN... we get an x-ray. We never consider a blind placement a success without that x-ray confirmation.

[Double-Helix, BSN, RN]

An x-ray at placement is imperative.

For subsequent placement checks, you would follow your facility's policy. You will check the measurement where the tube is taped at the nare and compare it to the length documented on insertion. If there's a discrepancy in length, you need to escalate to the doctor. Many facilities also check the pH of aspirated gastric contents. While there is a difference in pH gradient between the stomach and the small intestine, it can vary quite a bit and doesn't reliably indicate placement in the duodenum vs stomach. Generally you'll find out about misplacement if the patient is clinically symptomatic (like vomiting feeds that are usually tolerated via the D tube) and an x-ray is ordered to check placement.