Is moisture on a Nasogastric Tube (NGT) a sign of incorrect placement?

Moisture on NGT Is NOT a Reliable Sign of Wrong Placement

Moisture on a nasogastric tube should never be used as a method to verify correct or incorrect placement, as it is not mentioned in any evidence-based guidelines and has no diagnostic value for determining tube position. 1

Why Moisture Cannot Determine Placement

The presence or absence of moisture on an NGT provides no information about whether the tube is in the stomach, esophagus, or respiratory tract because:

• Moisture can be present regardless of location - The tube may encounter secretions in the nasopharynx, esophagus, stomach, or even respiratory tract 1
• No guideline or evidence supports moisture assessment - Neither the American Gastroenterological Association nor the European Society for Clinical Nutrition and Metabolism mention moisture as a verification method 1
• This is a dangerous assumption - Relying on unreliable bedside methods has led to serious complications including lung placement, pleural cavity insertion, and esophageal perforation 1, 2

Evidence-Based Methods for Verifying NGT Placement

Gold Standard Method

• Radiographic confirmation is mandatory before initiating feeding - Every patient must undergo chest/abdominal X-ray to confirm proper gastric position 1
• This is the only method that reliably identifies tubes that have entered the lung, pleural cavity, or coiled in the esophagus 1

Alternative Bedside Methods (When Radiography Unavailable)

• pH testing of aspirate - Gastric aspirate should be pH <5.5, though this cannot distinguish between gastric and respiratory placement in all cases 1
• Colorimetric capnometry - Shows 97.5% consistency with radiological confirmation and can detect esophageal placement (sensitivity 1.00, specificity 0.667) 3, 4
• Capnography - Strong evidence supports its use in mechanically ventilated patients to identify inadvertent airway intubation 5, 4

Critical Pitfall to Avoid

Never rely on auscultation alone - The American Gastroenterological Association explicitly states that bedside auscultation is "unreliable and dangerous" with only 79% sensitivity and 61% specificity 1. The auscultatory method has 0.0 specificity in some studies 3.

Other Unreliable Methods

• Intra-abdominal palpation - A case report documented major morbidity from an improperly placed NGT that perforated the cervical esophagus despite the surgeon directly palpating what was presumed to be the tube tip in the stomach 2
• Visual inspection alone - Cannot differentiate between gastric, esophageal, or respiratory placement 1
• Failure to aspirate gastric contents - Should alert you to possible improper placement and mandate radiographic confirmation 2

Clinical Algorithm for NGT Placement Verification

1. Insert the NGT using proper technique - Position patient with head flexed forward, use appropriate size (8-12 French for adults), and lubricate thoroughly 1

2. Attempt to aspirate gastric contents - If no aspirate obtained, suspect malposition 2

3. If aspirate obtained, check pH - pH <5.5 suggests gastric placement, but this alone is insufficient 1

4. Obtain radiographic confirmation - Mandatory before any feeding or medication administration 1

5. In mechanically ventilated patients - Consider colorimetric capnometry or capnography as adjunct to detect respiratory placement 3, 4

6. Secure the tube properly - 40-80% of NGTs become dislodged without proper securement; consider nasal bridles for high-risk patients 1