What is the correct placement of NG tube?

Below the level of the carina the tube must not follow the course of either of the main bronchi, but should remain in the midline down to the level of the diaphragm where it passes through the gastro-oesophageal junction. The tip of the NG tube should be visible at least 10 cm beyond the gastro-oesophageal junction.

What is the most reliable method to confirm the placement of a newly inserted nasogastric NG tube?

The authors recommend always obtaining a chest radiograph (see the second image below) in order to verify correct placement, especially if the NG tube is to be used for medication or food administration.

What is the correct method for measuring the length of an NG tube for correct placement in the stomach?

Estimate the length of insertion by measuring the distance from the tip of the nose, around the ear, and down to just below the left costal margin. This point can be marked with a piece of tape on the tube.

What is the greatest risk related to NG tube migration?

Reflux of stomach contents into the oesophagus and risk of aspirationThe intraluminal presence of an NG tube may interfere with the lower oesophageal sphincter and cause reflux of stomach contents, leading to aspiration pneumonitis. The risk is increased when patients are fed when lying down flat.

How often do you verify NG tube placement?

NG tube placement is to be assessed:

1. Before each use of the tube for feeds and/or medications.
2. When a new tube is inserted.
3. When there is concern that the tube may have been pulled out or changed position.
4. There is choking, vomiting, coughing or breathing trouble.
5. Every 8 hours during a continuous feed.

What does a gastric pH of 4 mean?

Summary In patients with gastro-oesophageal reflux disease, the pH of refluxed gastric contents has a direct bearing on disease severity and oesophageal damage. A pH of 4 has been defined as a threshold below which refluxed gastric contents become injurious to the oesophagus.

How often does an NG tube need to be changed?

Long term NG and NJ tubes should usually be changed every 4–6 weeks swapping them to the other nostril (grade C).

How is the position of the nasogastric tube determined?

Nasogastric (NG) tube position on chest x-ray should be assessed following initial placement and on subsequent radiographs.

How is a chest X-ray used to determine the position of a NG tube?

Key points. If aspiration of gastric fluid following placement of an nasogastric (NG) tube is unsuccessful, then a chest X-ray can be used to help determine tube position. Oesophagus anatomy. A correctly positioned NG tube passes vertically down the oesophagus into the stomach.

Where is the tip of the NG tube supposed to be?

Below the level of the carina the tube must not follow the course of either of the main bronchi, but should remain in the midline down to the level of the diaphragm where it passes through the gastro-oesophageal junction. The tip of the NG tube should be visible at least 10 cm beyond the gastro-oesophageal junction. Correct NG tube position

When to remove a nasogastric tube ( NGT )?

›The desired outcome of inserting an NGT is to establish safe and effective enteral access with minimal patient discomfort, trauma,or other complications. The tube is removed when its diagnostic or therapeutic function is no longer needed Why is Inserting and Verifying Placement of a Nasogastric Tube in the Adult Patient Important?