From the Guidelines
The placement of a nasogastric (NG) tube is confirmed on abdominal x-ray by visualizing the tube's course as it passes through the esophagus and into the stomach, with the tip ideally positioned in the body of the stomach below the gastroesophageal junction. Proper positioning is indicated when the tube is seen crossing the midline to the left after passing through the esophagus and when the tip is visible below the diaphragm but above the gastric bubble. The tube should follow the expected anatomical path without coiling or kinking. Radiologists look for the tube to pass through the carina and continue inferiorly, avoiding entry into the bronchial tree. If the tube appears to enter the lungs or shows unexpected looping, it is malpositioned and requires immediate removal and replacement. This radiographic confirmation is essential because clinical methods like auscultation or pH testing can be unreliable, and misplacement can lead to serious complications including aspiration pneumonia if feeding is initiated through an improperly placed tube, as highlighted in the study by 1.
Key Considerations for NG Tube Placement Confirmation
- The use of radiographs for confirming NG tube placement is the gold standard, as stated in the study by 1.
- Clinical methods such as auscultation or pH testing are not reliable for confirming NG tube placement, as noted in the studies by 1 and 1.
- The tip of the NG tube should be positioned in the body of the stomach below the gastroesophageal junction.
- The tube should follow the expected anatomical path without coiling or kinking.
- Radiographic confirmation is essential to prevent serious complications such as aspiration pneumonia.
Importance of Radiographic Confirmation
The study by 1 emphasizes the importance of radiographic confirmation for NG tube placement, citing that between 2005 and 2010,45% of all cases of harm caused by misplaced nasogastric tubes reported by the National Patient Safety Agency were due to misinterpreted radiographs. This highlights the need for accurate and reliable confirmation methods, such as radiographs, to ensure patient safety. In contrast, the studies by 1 and 1 provide additional context on the limitations of clinical methods for confirming NG tube placement, but the most recent and highest quality study by 1 takes precedence in guiding clinical practice.
From the Research
Confirming NG Tube Placement using Abdominal X-ray
- The placement of a nasogastric (NG) tube is crucial for patients' safety and wellbeing, and abdominal x-rays are sometimes used to confirm the correct positioning of the tube 2.
- Studies have shown that x-rays can be effective in determining the position of NG tubes, with one study finding that 70% of tubes were in the stomach, 21% were in the oesophagus, and 4% were in the airways 2.
- However, another study found that x-ray checks of NG tube position can be delayed, with 51% of placements delayed by more than 2 hours, and 33% of patients requiring more than 3 x-rays during their enteral episode 3.
- The use of x-rays to confirm NG tube placement can also be associated with clinically significant delays to drug treatment and nutrition, highlighting the need for guided or combined methods of confirming tube placement 3.
Best Practices for Verifying NG Tube Placement
- Best practices for verifying ongoing placement of NG tubes after initial x-ray confirmation include marking the tube with inedible ink or adhesive tape where it exits the nares, checking tube location at 4-hour intervals, and checking placement/patency in patients who complain of pain, vomiting, or coughing 4.
- Adherence to these evidence-based strategies can promote patient safety and reduce the risk of complications associated with misplaced NG tubes 4.
- Regular monitoring of practice changes is critical to determine whether a best practice is sustained, and electronic health records must be current to guide and support evidence-based nursing practice 4.