CHECKING TUBE PLACEMENT

1. Ask the client to talk • Client would be unable to talk if the NGT has passed through the vocal cords

2. Check posterior pharynx for presence of coiled tube
• Tube is pliable and can only coil at the back of pharynx instead of advancing into the esophagus

3. Attach the asepto syringe to the end of the naso gastric tube. Place diaphragm of stethoscope over the left quadrant of the abdomen just below the costal margin. Inject 10-20 cc of air while auscultating the abdomen.
• Air present in the stomach create “whooshing sound” and confirms tube placement in the stomach. Absence of sound, indicates that the end of the tube is still in the esophagus.

4. Aspirate gently back or obtain gastric contents.
• Placement of tube in the stomach will result in return of gastric contents.

5. Gently mix aspirate in syringe, and expel into the medicine cup. Measure pH of aspirate by dipping the pH strip into the fluid. Compare the color of the strip with the color on the chart.
a. pH 1-4 = gastric fluid from client who has fasted for at least 4 hour
b. pH>6 = fasting client
c. pH 5 and > = client with continuous tube feeding
d. pH>6 = pleural fluid from tracheobronchial tree

6. Dip the opened end of the NGT into a glass of water and instruct the client to take deep breath and exhale
• Presence of bubbles in the glass of water may indicate that the tube is in the tracheobronchial tree.