Nasogastric Tube Placement: Proper Termination in the Stomach
Yes, a nasogastric (NG) tube is specifically designed to terminate in the stomach. This is essential for proper function and patient safety, as confirmed by multiple clinical guidelines 1.
Proper NG Tube Placement
Definition and Purpose
An NG tube is defined as "a flexible synthetic tube that is inserted into the stomach through the nostril to provide feeding and/or decompression" 1. The proper termination point is always the stomach, as indicated by its name (naso-gastric).
Anatomical Considerations
The tube follows a specific path:
- Insertion through the nostril
- Passage along the nasopharynx
- Through the esophagus
- Final termination in the stomach 2
Verification of Proper Placement
Confirming correct placement is critical as misplacement can lead to serious complications:
pH Testing of Aspirate:
- Primary bedside verification method
- More reliable than litmus paper tests 3
Radiological Confirmation:
- Remains the "gold standard" for verification 3
- Essential when there is any doubt about placement
Unreliable Methods (should NOT be used alone):
- Auscultation (listening with stethoscope)
- Observing for bubbling
- These methods are not evidence-based for confirming placement 3
Clinical Implications of Improper Placement
Misplaced NG tubes can result in:
- Respiratory Complications: Tubes may inadvertently enter the trachea and lungs 4
- Perforation Risk: Possible perforation of the esophagus or other structures 5
- Ineffective Therapy: Feeding or medication administration into incorrect locations 3
Important Cautions
- Never assume proper placement based on external indicators alone
- Intra-abdominal palpation during surgery is not a reliable indicator of proper placement 5
- Failure to aspirate gastric contents should raise immediate concern about improper placement 5
- Misplacement and subsequent use of an NG tube is considered a "never event" in healthcare 2
Distinguishing NG from Other Enteral Tubes
Different types of enteral tubes have different termination points:
- NG tubes: Terminate in the stomach
- NJ tubes: Terminate in the jejunum (small intestine)
- OG tubes: Enter through the mouth but terminate in the stomach 1
Duration Considerations
- NG tubes are typically used for short-term access (up to 4-6 weeks)
- For longer-term feeding needs, percutaneous options like gastrostomy should be considered 1
Remember that verification of proper placement is not a one-time event but must be performed regularly, especially before administering anything through the tube, to ensure continued proper positioning in the stomach.