Verification of NG tube placement

[Bwick]

Help! I'm reviewing our enteral nutrition policy. I would like to see that we get a chest X-ray or KUB to verify placement in a patient with an NG tube. Basically if anything is going into the tube (meds and/or feeding) we should have more evidence of placement than listening for air.

What does your hospital do?

Thanks

[skyQ]

After the insertion of the NG tube the pt will go for x-ray to confirm the placement, after the placement is confirmed the nurse will put a black mark on the tube closed to the nostirl, and measure the length of the tube from the exit site to let say the blue rubber part( the port). and listen for the bubbling sounds over the stomach. We have to do the 3 checks qshift.

[misishana]

my hair is falling off thinking about this!

im doing some research about verify ng tube, in the clinical practice book said auscultate cannot be use. but why the hospitals still approve the technique?

why dont they dont do a good standard so that we didnt confused?

[tewdles, RN]

My experience is that NGs are verified by xray after insertion. They are measured and marked and checked by aspiration and auscultation each shift or each time they are used.

If the tube is replaced, it is re-x rayed. Of course, I have been practicing since the stone age so...

[Sunnysidegirl]

In my facility, A Dr will order an x-ray before anything is placed in the tube.Auscultation is NOT reliable! The sound you hear does not distinguish whether the tube is in the stomache,espophagus, or small bowel.P.H testing is more reliable.My nursing instructor told us a gruesome story of two RN's who both verified placement by auscultaion,however the tube was in the pt's brain and consequently died.In my opinion, You can't be too careful when it comes to tube placement.

[Sunnysidegirl]

Re: Verification of NG tube placement

[Sunnysidegirl]

i have been reading the posts (sorry i am joining the discussion late). we are looking at redoing our policies/procedures but have to use evidenced based practice no more that 2-3 years old. having trouble finding any that recent. can anyone direct me to a good site? this is a pediatric/picu/nicu area.

thanks

i just did a presentation on ngt's and got alot of information from the american society for parenteral and enteral nutrition (aspen). they did a special report recently in the journal of parenteral and enteral nutrition.below is the link.

hope that helps.

http://www.nutritioncare.org/workare...t.aspx?id=3128