Best Practices for Confirming NG Tube Placement
Don Marcello
Nasogastric (NG) tubes are a phenomenal way to provide a person with nutrients and medication when they are unable to ingest food and liquids normally. However, NG tubes are only effective if those who perform their placement do so properly. As such, confirming the placement of an NG tube is a crucial part of NG tube feeding. This post will teach you the best practice method for confirming NG tube placement and cover a few related topics as well.
Best Practice Method for Confirming NG Tube Placement
The best practice method for confirming NG tube placement is to use a pH test. It’s true that there are a few methods for testing NG tube placement, but pH tests typically prove to be the more advantageous option for one or more reasons. For instance, pH tests are often relatively easy to perform, and they provide results more quickly than other placement confirmation means.
How to Confirm NG Tube Placement Using a pH Test
Now that you are aware that using a pH test is the best practice for testing NG tube placement, it will be helpful to learn how to perform one of these tests. In this section, we’ll provide a brief general outline of what the process entails.
Preparing to Confirm NG Tube Placement
Before you attempt to confirm the placement of an NG tube, it is important to collect the tools you’ll need throughout the process. Here is a quick list of the items you’ll need:
- Gloves
- An irrigation syringe
- A pH testing kit
It is equally important to ensure that all of those items are sterile before you use them. Likewise, be sure to wash your hands thoroughly and put on a pair of gloves before moving to the next step.
Collecting Stomach Fluid
The next step in the process when confirming NG tube placement is to collect stomach fluid via the NG tube. To do this, connect the irrigation syringe to the end of the NG tube. Then pull the plunger of the syringe until fluid flows through the NG tube and begins to fill the syringe’s barrel.
Testing the pH
After collecting the stomach fluid, it is time to test it to see if it has a pH that indicates the tube is at the proper depth. At this stage, some kits will provide pH strips that allow you to test the fluid’s acidity. However, there are also pH testing tools specially designed for this process that connect to the syringe and allow for a nearly instant color-coded reading.
Regardless of the pH testing method you use, it is vital to understand what pH threshold to keep in mind. Generally, a pH reading of 4.5 or lower indicates that the tube is at the proper depth and, thus, the placement is correct. Still, as the next section will show, there are other factors to consider when confirming NG tube placement.
Monitoring Other Factors
It’s good practice to use a pH test while monitoring other factors as well. For instance, certain visual cues can give an indication of whether or not an NG tube has had a successful placement.
In most cases, those who perform placement will mark the NG tube at the point where it exits the person’s nostril with a marker. Noting the presence of this mark at the beginning and end of the confirmation process helps ensure that the tube is properly placed and has not shifted. Noting a person’s overall state and any level of discomfort should be done as well.
Other Methods for Confirming NG Tube Placement
While using a pH test is the best practice method for testing and confirming NG tube placement, there are other viable methods, one of which is X-ray. X-ray NG tube placement confirmation is effective, but it has some downsides compared to pH tests. Mainly, X-ray confirmation takes longer to provide results, exposes the person to radiation, and is less convenient overall.
Additionally, there is another method known as the woosh test, which involves forcing air down the NG tube. Nurses have used the woosh test method in the past to test tube placement in the absence of more sophisticated methods. However, the efficacy of the woosh test is highly questionable to the point where many medical professionals recommend avoiding it.
When to Confirm NG Tube Placement
Part of the reason why confirming NG tube placement is so important is that you’ll need to do it often during the period of time in which a person is using a tube for feeding. Here is a list of instances when you should confirm NG tube placement:
- Immediately after placing an NG tube
- Before performing an NG tube feeding
- After replacing or adjusting an NG tube
Keep in mind that the above instances are times in which you must test NG tube placement to ensure the safety of the person relying on the tube. However, an NG tube placement confirmation can be useful any time you suspect the tube has shifted out of place or if you simply want to reconfirm its correct placement.
Why is Testing NG Tube Placement Important?
The primary reason why testing NG tube placement is so important is that proper placement is the best way to ensure that the person using the tube will remain safe and healthy while receiving the nutrients and fluids they need via the tube.
Unfortunately, NG tube misplacement can lead to complications that range in severity. At times, NG tube misplacement can cause mild discomfort. In other scenarios, misplacement can become life-threatening, especially when administering medication via a misplaced tube.
The potential that those negative outcomes could occur is all the more reason to learn how to place and use an NG tube properly. A critical part of that knowledge is understanding and regularly employing the best practice method for confirming NG tube placement.
