How to check g-tube placement with stethoscope

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• Pediatr Nurs. 2004 Nov-Dec;30(6):458. Corrected order of Author Names

Numerous published studies have demonstrated that conventional methods for documenting proper position of orally or nasally placed feeding tubes in adults are inaccurate. The few available studies done in children indicate similar inadequacies. Auscultation after insufflation of air over the stomach and other less common practices used to verify proper tube position have been shown to be ineffective in predicting correct tube position. Checking pH of aspirate has be recommended as a better method to confirm feeding tube position at the bedside. Careful review of the literature and appropriate application of research findings can lead to change in time-honored nursing practices. Although change is often difficult, a coordinated effort by nurses across organizational lines may facilitate the process.

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• Comparison of 2 methods for postpyloric placement of enteral feeding tubes.

  Lenart S, Polissar NL. Lenart S, et al. Am J Crit Care. 2003 Jul;12(4):357-60. Am J Crit Care. 2003. PMID: 12882067 Clinical Trial.

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• Effectiveness of the auscultatory and pH methods in predicting feeding tube placement.

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Cited by

• Naso-enteric Tube Placement: A Review of Methods to Confirm Tip Location, Global Applicability and Requirements.

  Milsom SA, Sweeting JA, Sheahan H, Haemmerle E, Windsor JA. Milsom SA, et al. World J Surg. 2015 Sep;39(9):2243-52. doi: 10.1007/s00268-015-3077-6. World J Surg. 2015. PMID: 25900711 Review.

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Nurses must learn to place nasogastric tubes into patients correctly so that they can receive the medical services that they need. Even seasoned nurses who have mastered the skill of nasogastric tube placement must follow certain measures to verify the placement of the tube. The verification methods are a relatively easy clinical skill as long as nurses follow certain measures.

Importance of Correct Nasogastric (NG) Tube Placement

Nasogastric tube placement is important to patients for a number of reasons. One reason is that that the tube can release liquid and air contents from the stomach of the patients. Those suffering from gastric or intestinal obstruction must have their NG tubes placed correctly to prevent the patient from vomiting the contents of the stomach. Proper placement of the NG tube is also important to patients suffering from strokes or tracheotomies because it is a useful tool for feeding the patients.

Methods Used to Check Correct Placement of Nasogastric (NG) Tube

Nurses can check the placement of the patient’s NG tube by using one of the following methods:

• Chest X-ray – This method offer one of the best ways to check the placement of the NG tube. The method is generally uses for confused patients and those in the Intensive Care Unit as well as patients with swallowing issues. The nurse X-rays the upper portion of the patient’s abdomen, looking for an opaque, white line on the left side under the diaphragm.
• Syringe test – This method is not uses very often anymore. The syringe test or “whoosh test” checks the placement of the tube by using a stethoscope to listen for the whooshing sound as a syringe instills a 30cc air bolus in to the patient’s stomach.
• pH test – This method aspires the NG tube and checks the content by using pH paper. If the ph is 5.5 or less, the tube has be properly placed.

Steps on How to Check Nasogastric (NG) Tube Placement

Once the nurse places the NG tube, it is necessary to use methods to check the placement of the tube. In certain instances, the tube is not positioned correctly so the nurse has to start the process from the beginning and continue until the NG tube is placed correctly. The following are the steps to check NG tube placement:

1. Wash the hands with soap and warm water for at least 15 seconds before verifying the placement of the tube.
2. Nurses can verify the placement of the tube by performing two of the following methods: ask the patient to hum or talk ( coughing or choking means the tube is properly placed); use an irrigation syringe to aspire gastric contents; chest X-ray; lower the open end of the NG tube into a cup of water ( bubbles indicate that the tube is in place); or place a stethoscope over the patient’s epigastrum while instilling a 30 cc air bolus using an irrigation syringe (the air enters the stomach when a whooshing sound is heard).
3. In certain instances, it may still not be possible to confirm that the NG tube is in the patient’s stomach. The nurse should immediately remove the tube and start the process from the beginning.
4. It is important to secure the tube once placement of the NG tube is confirmed. Prep the patient’s nose by cleaning and drying the area before applying the tape to the patient’s skin. Wrap a long piece of tape around the visible end of the NG tube and the other end of the tape at the very end of the patient’s nose.
5. For added security, clamp or connect the NG tube if necessary. Ensure that the blue pigtail stays at the level of the fluid contained in the patient’s stomach when using a Salem sump tube or the likelihood of leakage of the gastric contents in a patient’s stomach is possible.

Complications from Improper Nasogastric (NG) Tube Placement

Complications that can result from improper NG tube placement include pneumothorax, pulmonary hemorrhage, pleural effusion, empyema, trauma injuries, abscess formation, nosebleeds, asphyxia, secondary infections, pneumonitis, and development of tracheal-esophageal fistula. Other complications that can occur from improper tube placement include tube migration, perforation of the tube, and tube obstruction.

Checking the placement of a patient’s NG tube is a relatively easy process to execute as long as nurses follow a few easy steps to ensure the correct placement. Patients depend on nurses to make sure that the patient has a comfortable experience during the stay at a medical facility.