CLINICAL QUERIES: How do I verify NG tube placement?

August 2005 
Volume 35  Number 8
Pages 25 - 25
  PDF Version Available!

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I have an adult patient who's receiving feedings via a nasogastric (NG) tube. Tube placement was verified by X-ray after insertion, so why do I need to reconfirm placement before administering a feeding? —H.P., LA.

Judy Sweeney, RN, MSN, replies: Rule number one is never put anything in an NG tube unless you know that its tip is in the stomach. Although an X-ray taken immediately after tube insertion confirms NG tube placement at that time, the tube can become displaced later. Where could it go? It can migrate up the esophagus and into the lungs, or it can move down into the duodenum. Or a portion of tubing may coil in the pharynx. Risk factors for NG tube displacement include decreased level of consciousness, confusion or agitation, poor or absent gag or cough reflexes, and endotracheal intubation.

At the bedside, I use the AAA system to remember the steps to ensure correct NG tube placement and prevent aspiration. You can use this method if the NG tube is being used for suction or for feeding. ...

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