Can You Confirm NG Tube Placement Without X-Rays?

When verifying nasogastric (NG) or orogastric (OG) tube placement, accuracy is essential—but it shouldn’t come at the cost of patient safety or workflow delays. While X-rays have long been a go-to method, they’re not without limitations. Today, safer and faster alternatives like gastric pH testing offer immediate, radiation-free confirmation—right at the bedside.

Tube misplacement can lead to complications such as aspiration pneumonia, extended hospital stays, and increased care costs. Reducing those risks starts with choosing the right verification strateg

The Limitations of X-ray Verification

X-rays remain a useful tool in complex or unclear cases, but as a routine verification method, they can introduce unnecessary delays and exposure. Common drawbacks include:

• Radiation exposure, especially concerning for neonates and pregnant patients
  
  
• Delays in feeding or medication administration while awaiting imaging
  
  
• Higher costs due to equipment use, staff time, and radiologist interpretation
  
  
• Workflow bottlenecks during high-acuity care or shift transitions
  
  

These challenges have prompted many healthcare teams to look for alternatives that support faster decisions, protect patients from radiation, and streamline care delivery.

Gastric pH Testing: A Proven Alternative

Gastric pH testing offers a clinically validated way to confirm NG/OG tube placement without the risks or delays of radiographic imaging. The stomach’s naturally acidic environment—typically pH 1 to 5.5—provides a reliable marker that differentiates gastric placement from misplacement in the respiratory tract, where pH is usually higher.

This method provides objective data at the point of care, supporting faster clinical decisions and helping reduce the risk of feeding or medicating through a misplaced tube.

How Gastric pH Testing Works

The stomach produces hydrochloric acid, creating a distinct acidic environment with a pH typically between 1 and 5.5. This acidic signature differs significantly from other body areas where a tube might mistakenly be placed. The respiratory tract, for instance, has a more neutral pH, usually above 6.

When gastric pH testing shows a reading of 5.5 or below, it’s a strong sign that the tube is correctly positioned in the stomach instead of elsewhere. This biological marker offers objective data for healthcare providers to make informed decisions about tube placement without relying on subjective methods or radiation exposure.

Why pH Testing Makes Clinical and Operational Sense

Using pH-based verification offers these key benefits:

• Immediate results—no waiting for radiology or interpretation
  
  
• Zero radiation exposure
  
  
• Reduced risk of aspiration-related complications
  
  
• Lower reliance on costly or resource-intensive imaging
  
  
• Seamless integration into bedside workflows
  
  
• Greater confidence in placement decisions, especially in emergency or high-turnover units

The RightSpotpH® Indicator: Designed for Real-World Use

Developed by physicians in gastroenterology and emergency medicine, the RightSpotpH® Indicator was created to solve a persistent problem in modern healthcare: how to confirm NG/OG tube placement quickly, accurately, and without avoidable risk.

The device enables point-of-care pH measurement using a simple color-change method. Results are available in seconds, supporting safe clinical decisions without delay.

Available Variants

RightBio Metrics offers several options to support various care settings:

• RightSpotpH® Indicator: For standard NG/OG tubes in adult and general patient populations
  
  
• RightSpotpH® ENFit Indicator: Compatible with ENFit systems, helping prevent misconnections
  
  
• RightSpotpH® SmallBore Indicator: Tailored for tubes 10Fr or smaller, ideal for neonatal and pediatric use

Where pH Testing Fits Best

The RightSpotpH® Indicator supports fast, confident verification across care environments:

• Emergency departments: Where every minute counts and radiology access may be limited
  
  
• ICUs: Where patients often can’t express discomfort or warning signs
  
  
• NICUs: Where radiation avoidance is especially important for fragile infants
  
  
• General med-surg and post-acute care: Where consistent, evidence-based protocols reduce complications
  
  

Many hospitals now incorporate pH testing into standard placement protocols, reserving X-rays for select cases. Implementation typically involves brief staff training, protocol updates, and defining criteria for when secondary verification is appropriate.

Supporting Safer, More Efficient Care

Preventing tube misplacement protects patients from serious complications, including aspiration pneumonia, prolonged hospitalization, and unnecessary exposure to radiation. When facilities transition to pH testing as the first-line verification method, they often report:

• Shorter time to treatment
  
  
• Fewer repeat placements or delayed feedings
  
  
• Lower radiology demand and associated costs
  
  
• Improved workflow efficiency and team satisfaction
  
  

The RightSpotpH® Indicator supports these outcomes by putting fast, reliable verification directly in the hands of clinical staff.

See It in Action

Want to explore how pH-based verification can improve care delivery at your facility? Contact us to schedule a live demonstration. We’ll walk through how the RightSpotpH® Indicator works, how it integrates into your current workflow, and how other hospitals are using it to improve safety and efficiency.

Contact Us to Setup a Live Demo