What Are the Most Reliable Methods for Confirming NG/OG Tube Placement?

Accurate verification of NG and OG tube placement is essential for preventing serious complications, including aspiration pneumonia, lung injury, and, in the most severe cases, patient death. Yet despite how routine the procedure is, incorrect placement still occurs—and the consequences are costly.

With verification protocols under increased scrutiny across ICUs, NICUs, EDs, and long-term care, clinicians need fast, safe, and evidence-based tools that support both safety and efficiency.

Why Accurate NG/OG Tube Verification Matters

NG and OG tubes are placed for a wide range of clinical purposes, from nutritional support to medication delivery. When positioned incorrectly—especially in the trachea or respiratory tract—the result can be immediate harm. Misplaced tubes are particularly dangerous in patients who are sedated, unconscious, or otherwise unable to communicate discomfort.

Avoiding these complications starts with choosing the right verification method—one that provides reliable confirmation without delay or unnecessary exposure to risk.

Traditional Methods vs. Evidence-Based Approaches

Auscultation

The long-standing “whoosh test” involves injecting air and listening for gastric sounds with a stethoscope. While once considered standard, studies have shown that auscultation has a high false-positive rate. Air can create misleading sounds even when the tube is mispositioned in the lungs. Major safety organizations have called for its retirement, citing its unreliability.

X-ray Imaging

Radiographic verification offers visual confirmation but presents challenges of its own:

• Radiation exposure, especially problematic for neonates and repeat verifications
  
  
• Workflow delays while waiting for imaging and interpretation
  
  
• Cost and resource use, particularly in emergency or rural care settings
  
  

While still valuable in certain complex or inconclusive cases, X-rays are no longer ideal as a first-line tool.

Gastric pH Testing: An Evidence-Based First-Line Option

Gastric pH testing is now widely recognized as the most reliable and efficient method for confirming NG/OG tube placement. It leverages a simple biological reality: the stomach has a distinctly acidic environment, with pH typically ranging between 1 and 5.5. This offers a clear, objective marker that helps differentiate gastric placement from other anatomical locations.

How It Works

1. Aspirate fluid through the NG or OG tube
   
   
2. Apply the aspirate to a pH-sensitive indicator
   
   
3. Confirm placement with a reading of pH ≤ 5.5
   
   

The entire process takes seconds and can be done at the bedside—no radiology, no transport, no waiting.

Clinical Benefits of pH Testing

Facilities that implement pH testing as their primary verification method report measurable improvements in patient safety, workflow efficiency, and overall care quality.

Benefits include:

• Immediate confirmation at the point of care
  
  
• Elimination of radiation exposure
  
  
• Reduced verification delays
  
  
• Decreased reliance on radiographic imaging
  
  
• Fewer misplacements and associated complications
  
  
• Increased staff confidence in placement decisions

RightSpotpH® Indicators: Solutions That Support Real-World Practice

RightBio Metrics offers a suite of FDA-cleared pH indicators designed specifically for clinical use across diverse patient populations and settings.

• RightSpotpH Indicator: A versatile solution for most NG/OG tubes in general care and critical care environments
  
  
• RightSpotpH ENFit Indicator: Designed to integrate with ENFit enteral systems and prevent misconnections
  
  
• RightSpotpH SmallBore Indicator: Tailored for neonatal and pediatric tubes (10Fr or smaller), ideal for NICUs and pediatric ICUs
  
  

Each device was developed by physicians with firsthand experience in managing the risks of tube misplacement, ensuring they meet the practical needs of today’s healthcare teams.

Best Practices for Safer NG/OG Tube Verification

To optimize patient outcomes, facilities should adopt consistent, evidence-based verification protocols. Key practices include:

• Making pH testing the standard initial method for all NG/OG placements
  
  
• Reserving X-rays for cases where pH testing is inconclusive or not possible
  
  
• Verifying tube position:
  
  
  • Immediately after insertion
  • Before each administration of medication or nutrition
  • After episodes of vomiting, coughing, or suspected dislodgement
  • Per facility protocol for continuous use (typically every 4–24 hours)
    
    
• Documenting verification results clearly and consistently
  
  

Clinical Impact: Safer Patients, Smoother Workflows

Clinicians who shift to pH-based verification report lower complication rates, improved efficiency, and fewer delays in patient care. For facilities, the benefits extend to reduced costs, improved patient satisfaction, and decreased liability associated with adverse events like aspiration pneumonia.

By making gastric pH testing standard practice, hospitals can significantly reduce cases of non-ventilator hospital-acquired pneumonia (NV-HAP), a costly and preventable condition that still affects thousands of patients each year.

See the RightSpotpH Indicator in Action

RightBio Metrics offers live demos to help your team see how easily pH verification fits into existing workflows. Schedule a walkthrough to explore how the RightSpotpH family of products can improve outcomes and reduce unnecessary complications at your facility.

Contact Us to Setup a Live Demo