Emergency Nursing Resource: Gastric Tube Placement Verification

Proehl, Jean A.; Heaton, Karen; Naccarato, Mary; Crowley, Melanie; Storer, Andrew; Moretz, Jason D.; Li, Suling

doi:10.1016/j.jen.2011.04.011

Cited by 14 publications

(21 citation statements)

References 20 publications

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“…It is recommended that caregivers should verify the placement of NG tube at initial use, before a feeding, before administration of a medication, and every shift unless otherwise indicated. [9] But there are still many aspirations that predispose tube-fed patients to pneumonia in clinical practice, especially those who are facing consciousness disturbance and those that are critically ill. Langmore SE prospectively enrolled 189 patients and determined that tube feeding was an independent predictor of aspiration pneumonia. [11] Another cross-sectional study included 102,842 patients showing that tube feeding is the third strongest of eighteen significant predictors of aspiration pneumonia.…”

Section: Discussionmentioning

confidence: 99%

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Potential Risk of Malposition of Nasogastric Tube Using Nose-Ear-Xiphoid Measurement

et al. 2014

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BackgroundCorrect placement of nasogastric tubes provide proper functionality and maximize benefit and minimize risk. The Nose-Ear-Xiphoid (NEX) body surface estimate method is a long-lasting technique, and this study was conducted to evaluate the correlation between NEX method and the secure insertion depth of nasogastric tube.Materials and MethodsThirty patients with nasogastric tube insertion who received whole body positron emission tomography with computerized tomography scan (PET-CT) were recruited. All data were gathered in the image center, which included Nose-Ear (NE), Ear-Xiphoid (EX), Nose-Ear-Xiphoid (NEX), glabella-xiphoid (GX) and glabella-umbilicus (GU) lengths. The distances of the inserted portion of the nasogastric tube between the cardiac and the nostril were measured by multiplanar reconstruction algorithm.ResultsOnly one patient successfully placed all side-holes into the stomach while using NEX method to estimate inserting depth. Twenty-nine patients (96.7%) failed to place correctly. Fourteen participants had one or more side-holes in both the esophagus and the stomach sides. Fifteen patients could not pass through any side-hole across the gastroesophageal junction. They had shorter EX distances (p = 0.02), but no difference among the NE distances. Body height had the highest statistical correlation with nasogastric tube length (adjusted R2 = 0.459), as compared with the NEX, GX and GU body surface methods.ConclusionThis study suggests that NEX method is inappropriate for adult patients to estimate the ideal inserting length of nasogastric tube. Physicians should realize these underinsertions with any side-hole above the gastroesophageal junctions may increase the potential risk of complications.

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Section: Discussionmentioning

confidence: 99%

“…[6]–[8] Verification of NG tube placement is recommended after initial tube insertion and before each intermittent feeding or medication administration. [9] …”

Section: Introductionmentioning

confidence: 99%

Potential Risk of Malposition of Nasogastric Tube Using Nose-Ear-Xiphoid Measurement

et al. 2014

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“…MAST trousers: In 1988, Moylan et al published a study that suggested that the increased use of endotracheal intubation, blood transfusion, larger volume of electrolyte resuscitation, and increased use of MAST trousers improved morbidity and mortality in air-transported patients. 3 However, in 1999, a Cochrane review concluded that there is no evidence to suggest that MAST/pneumatic antishock garment (PASG) application reduces mortality, length of hospitalization, or length of intensive care unit stay in trauma patients, and it is even possible that it may cause increases in these. There is no support for the continued use of MAST/ PASG in trauma patients.…”

Section: Checking Placement Of An Ngt Solely By Auscultationmentioning

confidence: 99%

Ten Things We Might Not Want to Do Anymore: How Research Changes Nursing Practice

Wolf

Carman

Henderson

et al. 2012

Journal of Emergency Nursing

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“…A common intervention for patients in a high acuity setting is the use of an NG tube. There are a variety of reasons why NG tubes are used, including: decompression of the stomach, removal of stomach contents to prevent aspiration, diminishing nausea and vomiting, and in some cases, administering liquids (feed) or medications (Proehl et al, 2011). An important nursing responsibility in caring for and assessing patients with NG tubes is verifying tube placement to prevent the occurrence of life--threatening complications (Proehl et al, 2011;Simons & Abdallah, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…There are a variety of reasons why NG tubes are used, including: decompression of the stomach, removal of stomach contents to prevent aspiration, diminishing nausea and vomiting, and in some cases, administering liquids (feed) or medications (Proehl et al, 2011). An important nursing responsibility in caring for and assessing patients with NG tubes is verifying tube placement to prevent the occurrence of life--threatening complications (Proehl et al, 2011;Simons & Abdallah, 2012). NG tube placement needs to be verified after initial insertion as well as before any feeding or administration of medications because NG tubes can easily become misplaced through "vomiting, coughing, retching, or suctioning [which] can cause the distal tip to migrate upward into the esophagus or downward into the duodenum" (Simons & Abdallah, 2012, p.40).…”

Section: Introductionmentioning

confidence: 99%

pH Testing as the Primary Method for Nasogastric Tube Placement Verification

Olson

2017

USURJ

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The placement of a nasogastric tube is a common intervention completed by nurses in the clinical setting. Correct placement of a nasogastric tube is critical for treatment and patient outcomes. There are many reasons for a nasogastric tube insertion and many methods of placement verification, but the two most common ways of assessing nasogastric tube placement are auscultation and pH testing. There are advantages and disadvantages to both the auscultation and the pH testing methods. The auscultation method is currently the method most commonly used in practice. However, the overall research analysis clearly suggests that the pH testing method is the most accurate and is accompanied by positive patient outcomes. Study limitations included small sample sizes and were often located outside of Canada, but all studies presented similar evidence in regards to auscultation versus pH testing. Finally, based on the analysis of the evidence, recommendations are made and barriers to implementation are outlined for practice regarding the implementation of the pH method.

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Emergency Nursing Resource: Gastric Tube Placement Verification

Cited by 14 publications

References 20 publications

Potential Risk of Malposition of Nasogastric Tube Using Nose-Ear-Xiphoid Measurement

Potential Risk of Malposition of Nasogastric Tube Using Nose-Ear-Xiphoid Measurement

Ten Things We Might Not Want to Do Anymore: How Research Changes Nursing Practice

pH Testing as the Primary Method for Nasogastric Tube Placement Verification

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