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Determining the Correct Placement of Gastric Tubes

It is common for patients in the intensive care unit to have some type of gastric tube placed for a variety of purposes (eg, drainage, medication administration, feeding). Although nurses place both large- and small-bore gastric tubes, there is constant discussion regarding the best method for validating proper placement at the time the tube is placed and during routine care thereafter. Radiologic confirmation of correct placement is considered the "gold standard."

	Here’s what you can do:

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• Evaluate unit and hospital policies and procedures for consistency with current best evidence.
  
• Assess the current standard practice by all nurses in your unit for determining correct gastric tube placement.
  
• Standardize the method for ensuring correct initial placement beforehand. Evaluation must be made prior to medication administration or initiation of tube feedings.
  
• Incorporate marking of the gastric tube once radiographic validation of placement has been determined.
  
• Determine the best bedside techniques and frequency for consistent ongoing evaluation of placement in your unit or institution. Do not rely on auscultation as the only method.
  
• Ensure that appropriate equipment for the bedside technique selected is consistently available.
  
• Incorporate changes into policies and procedures.
  
• Educate staff regarding standard of practice expectations and documentation requirements.
  

	Other helpful resources:

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• AACN Practice Alert: Verification of Feeding Tube Placement. Available at: http://www.aacn.org/AACN/practiceAlert.nsf/Files/VOFTP/$file/Verification%20of%20Feeding%20Tube%20Placement%2005-2005.pdf.
  
• Metheny NA, Meert KL. Monitoring feeding tube placement. Nutr Clin Pract. 2004;19(5):487-495.
  
• E-mail the AACN Practice Resource Network at practice{at}aacn.org.
  

Adapted from an AACN Practice Alert originally issued May 2005 (available at www.aacn.org) and published as a supplement to the article by Elpern and colleagues, "Capnometry and Air Insufflation for Assessing Initial Placement of Gastric Tubes" ( American Journal of Critical Care. 2007;16:544–550[Abstract/Free Full Text] ).

This Article Full Text (PDF) Respond to This Article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bell, L. Articles by Cox, B. Search for Related Content PubMed PubMed Citation Articles by Bell, L. Articles by Cox, B.