Reply To: checking NG Tube placement

  • Sherry Johnson

    September 9, 2019 at 12:08 pm

    What do you teach the families if the patient is receiving feeds/medications outpatient as 2 forms of verification?
    Length and gastric contents?  Do you teach them to check pH if they are not on PPIs?  If they can’t pull back gastric contents – just the length?

    Thank you

    Sherry Johnson, CPON,MSN
    West Memphis, AR
    United States
    Original Message:
    Sent: 09-09-2019 11:44 AM
    From: Cara Johnson
    Subject: checking NG Tube placement

    We recently changed our practice. Here is what we are doing (I also attached our education PP)

    • Children’s Hospital Organization sent out a Patient Safety Action Alert asking hospitals to immediately discontinue insertion of air bolus to assess/verify tube placement
    • Auscultation does not confirm tube placement:

    If tube is in esophagus can still have positive auscultation

    • CCHMC evidence summary does not recommend the practice of auscultation and supports the use of gastric aspirate and pH testing for verification
    • Obtain gastric aspirate using the 5-10 ml syringe

    –Only need enough aspirate to verify gastric contents

    –Gastric aspirate is usually cloudy and/or green, tan or off-white

    • Discard aspirates, Do Not re-feed

    Cara Johnson RNIII, BSN, CPON®
    Clinical Manager
    Hematology/Oncology Inpatient
    Cincinnati Childrens Hospital
    Work: (513)803-0306
    Cell: (513) 490-9253

    Original Message:
    Sent: 07-16-2019 11:21 AM
    From: Carly Coleman
    Subject: checking NG Tube placement

    ​Our institution is working on a EBP project to change our practice for checking NG tube placement at insertion and every 4 hours while in use for feeds.  Can anyone share what your institution does for your oncology population.  From our review of literature their concerns for PH paper testing with the H2 blockers and antacids and concern with such frequent x-ray exposure are making this challenging.  thank you.

    Carly Coleman, RN, PNP, CPHON
    Cohen Children’s Hospital