Verification of NG tube placement

allnurses Guide · Apr 19, 2005

X-ray check for placement.

steph

RNPATL, DNP, RN · Apr 19, 2005

We use a lot of dobhoff's at my hospital and they are xrayed for placement. For a standard NG tube (levine) - we do an xray for placement once, but then for continued placement verification, we rely on the nurses assessment through ascultation. Of course, anytime the nurse is uncomfortable with placement, she can call and get an order to double check placement, but it is not a general standard of practice unless the nurse feels it is necessary.

meownsmile, BSN, RN · Apr 20, 2005

We do a x-ray for placement unless it is completely obvious that it is in the stomache. If you get 500ml of green/brown or orange yuck when you connect to suction or gravity, its a pretty good bet you are in the stomache

allnurses Guide · Apr 20, 2005

I placed a ng tube in an intubated patient - physician was not concerned "there is no way an ng tube will go into the lungs with the patient being intubated". Auscultated - I heard air over the stomach. We x-rayed as per protocol . . the physician said "steph, come here for a sec" . . . . .walked over to the x-ray and there was the ng tube in the bronchus. :rolleyes:

Never say never.

steph

humglum, BSN, RN · Apr 20, 2005

Thankfully, its very rare we have a kid with an NG. Usually that would just be temporary until they can get a GT button. We'll check initial NG placement with x-ray and auscultate air into stomach to verify placement before each usage. I also aspirate gastric fluids not only to check placement but also to assess residual.

sjt9721, BSN, RN · Apr 20, 2005

Many of our procedural policies are referenced by a clinical skills text written by Perry & Potter. The book recommends aspirating & checking pH to determine if the tube is placed correctly. (Keeping litmus paper on the units leads to a point-of-care issue with lab...) However, I'm a fan of auscultation & x-ray.

Tweety, BSN, RN · Apr 20, 2005

We never check with an Xray on NG tube placement. If we hear air over the stomach and aspirate gastric contents, we proceed to use it.

The smaller tubes called KEO tubes or Dubhoff tubes, that are supposed to go into the duodenum we do check with an Xray. Usually, you can tell when you hit a bronch as the patient coughs and turns red, but not always. Happened once that we hit a bronchous and the patient was alert and asymptomatic.

mommatrauma, RN · Apr 23, 2005

We never check with an Xray on NG tube placement. If we hear air over the stomach and aspirate gastric contents, we proceed to use it.
The smaller tubes called KEO tubes or Dubhoff tubes, that are supposed to go into the duodenum we do check with an Xray. Usually, you can tell when you hit a bronch as the patient coughs and turns red, but not always. Happened once that we hit a bronchous and the patient was alert and asymptomatic.

what she said :)

barefootlady, ADN, RN · Apr 23, 2005

Agree with Tweety. One thing I noticed recently, staff nurse did not verify placement everytime he used tube. That is a big NO-NO in my book. Agree on litmus paper but has been years since I have actually had paper available. Doctor usually orders stat xray to check rather than wait for pharmacy to get paper. Wow, all of this points up to me again and again how long I have done this stuff. LOL

bobnurse · May 11, 2005

We X-ray all NG tubes used for feeding no matter what type of tube it is.....The only time we dont is if we set it up to suctioning.

Ive seen many ngt's go past the cuff in an intubated patient or patietn with a tracheostomy. Ive seen many ng's go in the lung and the patient had no cough reflex. Ive seen tube feeding infused into the lung after two nurses verified placement.

the safest way to ensure proper placement is with a CXR........

Bwick · May 11, 2005

Thanks to all that responded to my question. I think we will be changing our policy. :)