Nasogastric Tube: Insertion Verification

A nasogastric tube travels through the naris, pharynx, and oesophagus before its tip reaches the stomach. The route matters: a tube can pass beyond the mouth and appear correctly positioned at the nose while its distal tip has entered the tracheobronchial tree. If formula, medication, or gastric suction is then delivered through a respiratory-positioned tube, the patient can develop aspiration, severe pulmonary injury, pneumothorax, or death. The first verification after insertion is a chest or abdominal radiograph. The tube must not be used for feeding, medication administration, or suction until the required initial confirmation has been obtained and documented according to local policy. Radiography is used because it shows the tube’s course and tip directly rather than inferring location from a single bedside clue. Aspirate pH works by using the stomach’s acidic environment as a location clue. In the bedside pathway, a pH of 5.5 or lower confirms gastric placement. A higher pH does not prove that the tube is in the airway; it means gastric placement has not been confirmed. An inability to obtain aspirate is also an inconclusive...