Hanna Plager, BSN, RN
EDC Nursing and Patient Care Services | 2021
As a nurse on Ellison 12, Hanna knows that nasogastric tubes are commonly used in the inpatient setting. It is essential to confirm tube placement every day to ensure the safe delivery of nutrition, fluids, and medication to avoid complications. The gold standard to confirm placement is to obtain an abdominal x-ray. To check placement at the bedside without an x-ray, nurses can aspirate and look at the aspirate contents. However, nurses do not feel secure that tubes are in the right place by aspiration of contents alone. They could use auscultation; however, this practice is no longer recommended as it not evidence based. They can also check the depth of the insertion mark. Yet, these tubes can slightly shift and if the depth of the insertion mark number changes, nurses are inclined to ask for confirmation of tube placement with an x-ray. While awaiting this x-ray, care is delayed, and nurses cannot use the tube for anything. Nursing research has provided evidence that tube placement can be checked reliably by aspirating gastric contents and testing the pH. However, there is currently no means of testing the pH at MGH. Nurses must rely on radiography and non-evidence-based practice techniques. When nurses lack the ability to effectively check gastric placement at the bedside, this not only leads to more unnecessary x-rays, but also more delays in care and lengthened inpatient stays.