NG Tube Position Assessment
No, the NG tube is NOT in the correct position for feeding or medication administration. The tube tip is in the gastric fundus with the side port in the proximal stomach, which places critical drainage holes too high in the stomach for safe use.
Why This Position is Problematic
The fundus is the uppermost portion of the stomach, and having the tube tip terminate there means the side ports (drainage holes) are positioned in the proximal stomach rather than the body or antrum of the stomach. This creates several safety concerns:
- Inadequate drainage/decompression: If this tube is intended for gastric decompression, the fundal position will not effectively drain gastric contents, as fluid pools in the dependent portions of the stomach (body and antrum), not the fundus 1
- Feeding safety concerns: For feeding purposes, the American Gastroenterological Association requires radiographic confirmation of proper gastric position before initiating feeding, and the tube should be positioned to minimize aspiration risk 1
- Risk of tube migration: Tubes positioned in the fundus are more prone to coiling or migrating back into the esophagus, particularly given that 40-80% of NG tubes become dislodged without proper securement 2
Recommended Action
The tube should be advanced further (typically 5-10 cm) so the tip lies in the gastric body or antrum, with the side port well below the gastroesophageal junction.
- After repositioning, obtain a repeat abdominal radiograph to confirm appropriate placement before using the tube for feeding or medication administration 1
- The ideal position shows the tube tip projecting over the mid-to-distal stomach (body or antrum), clearly below the diaphragm and gastroesophageal junction 1
- Never rely on bedside auscultation alone, as it has only 79% sensitivity and 61% specificity for confirming position—radiographic confirmation is mandatory 1
Critical Safety Considerations
- Misplacement and subsequent use of an NG tube to administer feed, medication, or fluid is classified as a "never event" by healthcare safety organizations 3
- Improperly positioned tubes have been associated with considerable morbidity, including cases where tubes have perforated the esophagus, dissected the mediastinum, or entered the lung 4
- Before any feeding or medication administration, confirm that gastric contents can be aspirated and verify position radiographically 1, 4