How To Confirm NG/OG Tube Placement: Safe and Accurate Methods

The proper placement of nasogastric (NG) and orogastric (OG) tubes is essential for ensuring patient safety and effective delivery of medications, nutrition, and other therapeutic interventions. In this article, we will discuss reliable methods for confirming NG/OG tube placement and best practices for patient care.

Why is it Important to Confirm NG/OG Tube Placement?

Confirming the correct placement of NG/OG tubes is critical for several reasons:

  • To avoid the risk of serious complications, such as aspiration pneumonia or lung injury, due to misplacement
  • To ensure effective delivery of medications, nutrition, or other treatments
  • To meet patient safety guidelines and adhere to the recommendations of healthcare organizations

What are Three Ways to Confirm NG/OG Tube Placement?

pH Testing

pH testing is a reliable method for verifying the placement of NG/OG tubes. It involves measuring the pH of gastric aspirate obtained from the tube to determine if the tube is correctly positioned in the stomach. A pH value below 5.5 is generally considered indicative of proper tube placement.

Advantages of pH testing:

  • Relatively quick
  • No radiation exposure
  • Cost-effective

The RightSpotpH® Indicator product line provides a fully-closed system that is quick and sanitary for providers, and safe and accurate for patients.

X-Ray Testing

While the UK and the rest of the world use pH as the gold standard for verifying NG/OG tube placement, X-ray confirmation is more common in the  US. It involves taking an X-ray image of the patient’s chest and abdomen to visualize the tube’s position.

Advantages of X-ray confirmation:

  • Highly accurate
  • Can identify tube misplacement in the lungs or other anatomical structures

Disadvantages of X-ray confirmation:

  • Radiation exposure for the patient
  • Time-consuming
  • Requires specialized equipment and trained personnel
  • Expensive

Auscultation or "Whoosh" Test (not recommended)

The auscultation or “whoosh” test involves injecting a small amount of air into the tube while listening for a “whoosh” sound with a stethoscope placed over the patient’s stomach. This sound is believed to indicate that the air has entered the stomach, suggesting proper tube placement.

However, this method is not recommended due to its potential to cause serious harm and even death. Various studies and healthcare organizations, including the American Association of Critical-Care Nurses (AACN), have raised concerns about the accuracy and reliability of the auscultation test (Metheny et al., 2011; AACN, 2016).

Best Practices for Checking NG/OG Tube Placement

  • Follow recommendations and guidelines from leading healthcare organizations, such as the AACN and the 2011 Patient Safety Alert
  • Use reliable and accurate methods like pH testing or X-ray confirmation
  • Avoid using the auscultation or “whoosh” test
  • Consider using the RightSpotpH® Indicator product line to streamline the pH testing process and ensure accurate results

Confirming NG/OG tube placement is a critical aspect of patient care, as it ensures the safe and effective delivery of medications, nutrition, and other interventions. By using reliable methods such as pH testing and X-ray confirmation, healthcare professionals can minimize the risk of complications associated with tube misplacement. The RightSpotpH® Indicator product line offers a valuable tool for streamlining the pH testing process and providing accurate results.

It’s essential to follow best practices and guidelines from leading healthcare organizations and avoid using unreliable methods like the auscultation or “whoosh” test. By adhering to these recommendations, clinicians can promote patient safety and improve the overall quality of care for those requiring NG/OG tube placement.

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