Why Confirming Placement Of A Nasogastric Tube Is So Important

One of the most uncomfortable experiences for a patient in the hospital is the insertion of a nasogastric (NG) tube. This hollow, flexible tube is inserted through the patient’s nose, past the throat, and into the stomach. The tube inevitably passes over the nerves and muscles that control the gag reflex and may even cause the patient to vomit. Once in place, talking and swallowing can be painful and difficult.

You may be wondering why a patient would need to undergo the discomfort of an nasogastric tube in the first place. Actually, NG tubes have their benefits. Common indications for an NG tube include:

• Removal of stomach contents if food is not passing through the intestines because of blockage or loss of peristalsis (the wavelike motion that pushes food through the intestines as it is being digested)
• Determining if the stomach and intestines are functioning properly and whether certain health problems are present
• Controlling bleeding in the esophagus (the organ that connects your throat to your stomach)
• Decompressing a buildup of air and gases in the stomach after surgery
• Temporarily giving medication or feedings to someone who cannot swallow (e.g. a premature infant, someone who has had a stroke, or a patient in a coma)

Why is it so important to check for proper placement in the stomach before any treatment can begin? Think of the proximity between the esophagus and the trachea (windpipe). As the tube is going in, it is possible for it to miss the esophagus and travel instead down the windpipe and into the lungs. This is a potentially fatal mistake, especially if a doctor’s order calls for feedings and medication to be given through the tube. Accidentally feeding substances into the lungs can quickly cause coughing, difficulty breathing, sepsis, and death.

The current gold standard for confirming placement in the stomach and not in the respiratory tract is to take an X-ray of the chest and abdomen. Other techniques include:

• Measuring the tube length prior to placement and re-measuring once every shift
• Observing the appearance of the drainage and testing for acidity
• Pushing air through the NG tube and listening for a "whoosh" sound over the belly with a stethoscope

Research on the prevention and detection of misplaced NG tubes continues to show that all techniques, even X-rays, can be misinterpreted. Some methods are controversial because they can give false assurance that the tube is in the stomach. While X-rays are still considered the most accurate approach, it is up to the health care team to check and frequently recheck for proper placement in the stomach to avoid the serious and deadly consequences of misplacement.

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