What Are the Most Common Mistakes When Placing an NG/OG Tube?

Placing NG and OG tubes is a routine procedure—but it comes with real risks. Missteps during placement or verification can lead to aspiration, delayed care, preventable complications, or worse.

Whether you’re working in the ER, ICU, NICU, or general care unit, understanding the most common errors in tube placement helps you protect patients, streamline workflows, and reduce avoidable harm.

Mistake #1: Misplacing the Tube in the Airway

The most dangerous error is unintentional insertion into the trachea instead of the esophagus. This typically happens during initial placement—especially in sedated, unconscious, or neurologically compromised patients with reduced protective reflexes.

If feeding or medication is administered before verifying correct placement, the consequences can include:

• Aspiration pneumonia
• Respiratory distress or lung injury
• Death in severe cases

Always confirm placement before use. Clinical judgment, experience, and real-time feedback tools are all essential—but so is choosing a verification method grounded in objective data.

Mistake #2: Using Outdated Verification Techniques

Auscultation (“Whoosh Test”)

Still used in many hospitals, this method has been shown to yield false positives, and has no clinical evidence supporting its effectiveness or suitability for confirming tube placement. Air sounds can transmit to the stomach even if the tube is in the lungs. National safety organizations—including the AACN and NPSA—have called for its complete end.

Over-Reliance on X-rays

While effective in some cases, X-rays:

• Expose patients to radiation
• Cause delays in feeding or treatment (30 minutes to hours)
• Increase costs and staff burden

Use X-rays as a secondary check, not your go-to.

Mistake #2: Not Using pH Testing as the Primary Verification Method

Skipping pH testing—or failing to make it your first-line method—can lead to serious consequences. Without this step, you’re relying on outdated or less reliable techniques that increase the risk of misplacement, delayed treatment, and preventable harm.

Gastric pH testing is widely recognized as one of the most accurate and accessible methods for confirming NG/OG tube placement. The stomach’s naturally acidic environment (typically pH 1–5.5) creates a clear, measurable marker to verify correct positioning.

Failing to use pH testing may result in:

• Delayed detection of misplaced tubes
• Increased radiation exposure from unnecessary X-rays
• Higher risk of aspiration pneumonia
• Slower treatment initiation
• Greater healthcare costs
  

The RightSpotpH® Indicator is an FDA-cleared, evidence-based device developed by physicians to address these risks. It delivers real-time, bedside verification using a simple color-change pH reading—helping clinicians act quickly and confidently.

Mistake #3: Skipping Optimal Patient Positioning

Patient positioning directly affects tube trajectory and placement accuracy. For most adults, the safest position is:

• High Fowler’s (45–90° upright)
• Neck slightly flexed

Common issues include:

• Low head elevation
• Excessive neck extension
• Advancing the tube without correcting positioning first

Take a moment to position your patient well—it’s one of the simplest ways to prevent complications.

Mistake #4: Inconsistent Training or Technique

Tube placements are common—but training practices vary. Even experienced staff can fall into habits based on outdated guidance. Challenges we often hear include:

• Limited access to updated best practices
• Infrequent refresher training
• Difficulty recognizing subtle signs of misplacement
• Unfamiliarity with newer ways to test pH

Ongoing education and regular competency checks help close these gaps and build a stronger culture of safety.

Mistake #5: Not Rechecking Placement

Tubes can shift—even after successful placement.

Be sure to reconfirm in these situations:

• Before each feeding or med administration
• After coughing, vomiting, or suctioning
• Post-transport or procedures near the insertion site
• If the external tube marking changes position
• When new respiratory symptoms appear

Mistake #6: Using the Wrong Tube Size

The wrong tube size increases risk and complicates verification. Issues include:

• Tissue trauma from tubes too large
• Curling or coiling of small tubes during insertion
• Difficult aspiration, making pH testing unreliable
• Discomfort or distress for the patient

   

For smaller patients—including neonates—RightBio Metrics offers the RightSpotpH® SmallBore Indicator, designed for tubes 10Fr or smaller and built to deliver accurate, radiation-free confirmation in fragile populations.

Our devices are also available with ENFit Connectors.

Mistake #7: Incomplete Documentation

Thorough documentation protects your patients—and your team.

Include in your chart:

• Verification method used
• pH reading (if applicable)
• External tube length at the nare or lip
• Time and initials of verifying clinician

Incomplete records can lead to:

• Missed displacements
• Redundant X-rays
• Treatment delays
• Liability if complications arise

Moving Forward with Evidence-Based Practices

You can significantly reduce NG/OG tube placement errors by combining evidence-based tools with simple, repeatable protocols.

Here’s what works:

• Make pH testing your first-line verification method
  
• Use tools like the RightSpotpH® Indicator for instant bedside results
  
• Provide training that reflects current best practices
  
• Tailor tools to patient needs—SmallBore for neonates, ENFit-compatible for newer systems
  
• Reinforce accurate documentation at every step

See It in Action

Want to see how RightSpotpH® fits into your workflow? Schedule a live demo to explore how pH verification can reduce complications, save time, and protect your patients—without relying on X-rays.

Frequently Asked Questions