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Why are we not auscultating the lungs for NG tube placement?

Nurses   (510 Views | 7 Replies)
by NRnurse NRnurse (New) New Nurse

NRnurse specializes in ICU.

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I have a question: most of us would agree that auscultating the stomach area for NG tube placement verification (the "whoosh test") is not reliable enough and we need to do either CXR or litmus paper test. BUT, when we used to routinely do it, and for those of us who still do it (at least for the preliminary verification while waiting for an X-ray): why are we not auscultating the stomach AND the lungs when we push that air from the syringe? At least to compare the sound? Or is it normal to hear the air sound in the lungs, even if the tube is actually in the stomach? I recently was able to hear the air (whoosh) in both the stomach AND the lungs (the sound in the lungs was actually more loud and pronounced than in the stomach) while my fellow nurse was waiting for an X-ray to come in (not sure how that ended--didn't have a shift scheduled with her in a while to ask). What do you, guys, think? Any experience with it?

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RNperdiem has 14 years experience as a RN.

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In my limited experience, a tube in the lungs results in an uncomfortable patient who cannot stop coughing. X-Ray and aspiration gives good information, but out of habit, I do auscultate the stomach.

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1,717 Posts; 17,814 Profile Views

Also- generally speaking, an NGT in the stomach results in gak being suctioned out, confirming that it is not in the lungs.  

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1,139 Posts; 7,807 Profile Views

56 minutes ago, hherrn said:

Also- generally speaking, an NGT in the stomach results in gak being suctioned out, confirming that it is not in the lungs.  

I agree.  Generally when I put an NG down, I immediately get stomach contents back.  Do you not?  

If you were in the lungs you would hear coughing, no return, and possible desatting.  

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K+MgSO4 has 12 years experience as a BSN and specializes in Surgical, quality,management.

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Don't use litmus paper, use pH indicator paper, much more sensitive.

Tube in lungs results in coughing, spluttering and general shades of red or blue.  However, silent insertion is possible as well.

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PeeWeeQ has 1 years experience as a ADN, RN, EMT-B and specializes in Cardiac ICU.

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Just had a computer training module on this a few days ago. Apparently, the research shows that the because the stomach and the lungs are in close enough proximity that the test could yield deceptive results. 

It also that stated a tube in the lungs is not always symptomatic right away...

Thats what I remember from the CBL. I can look it up when I am there again and check for some sources for the info...

Edited by PeeWeeQ

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KatieMI has 6 years experience as a BSN, MSN, RN and specializes in ICU, LTACH, Internal Medicine.

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1) because results will still be deceptive. 

2) because you will forcibly push any oropharyngeal secretions which could hold onto the tip of the tube directly to the lung. 

Just like aspiration, tube insertion, especially when deep enough, can be completely asymptomatic for 24h and sometimes longer. Of course, if something is infusing through misplaced tube, symptoms will come back much sooner

Most commonly, NG tubes enter fundus of the stomach which is most commonly full of gas. One may get no back flow from tube till it drains gas out even if patient has stomach content. 

Edited by KatieMI

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51 Posts; 2,499 Profile Views

Per the protocol at my hospital, we only confirm placement by CXR.  While I know they were teaching both auscultation and pH testing back when I was in nursing school, neither can accurately guarantee correct placement like imaging can.  

As a side note, upon reading the words auscultating the lungs, I was reminded of a horrifying statement I once heard from a patient during assessment. After I listened to the upper lobes of the patient's lungs and was placing the stethoscope in postion to listen to the bases - the patient asked what I planned on listening to.  When I mentioned the lower lobes of his lungs, the patient said, "oh, I see... I think you're the first person to listen down there since I have been here..."  It wouldn't have been so horrific if he hadn't already been on the floor for five days... a med-surg floor... with no lower lobe auscultation!?!?!?  

Edited by ladedah1

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