Jason, a 22 y.o. accident victim, requires an NG tube for feeding. What should you immediately do after inserting an NG tube for liquid enteral feedings?
A. Aspirate for gastric secretions with a syringe.
B. Begin feeding slowly to prevent cramping.
C. Get an X-ray of the tip of the tube within 24 hours.
D. Clamp off the tube until the feedings begin.
Correct Answer: A. Aspirate for gastric secretions with a syringe.
Aspirating the stomach contents confirms correct placement. If feeding is planned through the tube, then it is imperative to confirm its location as placing feeds into the lungs can cause potentially fatal complications. The ideal location for an NG tube placed for suction is within the stomach because placement past the pylorus can cause damage to the duodenum. The ideal location for an NG feeding tube is postpyloric to decrease the risk of aspiration.
Option B: If the tube is being placed for the administration of medications or nutrition, intragastric placement must be confirmed. Introducing medication or tube feeds to the lungs can cause major complications, including death. Even in intubated patients, the NG tube can still be accidentally placed into the airway.
Option C: If an X-ray is ordered, it should be done immediately, not in 24 hours. Taking an abdominal x-ray is the best way to confirm the location of the tube, even if there is the aspiration of gastric contents as the tube may be placed past the pylorus where it will aspirate not just gastric secretions but also hepatobiliary secretions leading to persistently high output even when the patient’s acute issue has resolved.
Option D: Once the tube has been advanced to the estimated necessary length, correct location is often made obvious by aspirating out a large amount of gastric contents. Pushing 50 cc of air through the tube using a large syringe while auscultating the stomach with a stethoscope is a commonly described maneuver to determine the location of the tube, but it is of questionable efficacy.
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