Nasogastric Tube Placement: A Cross-Comparison of Verification Methods Used in Pennsylvania Hospitals and How They Align With Guidelines

Abstract

Nasogastric tubes (NGTs) are used as an alternative approach to deliver nutrition and medications, or a method to remove stomach contents. Insertion of these tubes is considered a simple procedure; however, wrong placement or dislodged tubes can lead to patient harm and possibly death. The risk of harm and death increases when misplaced or dislodged tubes are not identified prior to using them. We queried the Pennsylvania Patient Safety Reporting System for events that occurred between January 1, 2017, and June 30, 2020. We analyzed those reports that provided supplemental information describing NGT placement verification methods to determine how these activities aligned with NGT guidelines. The use of X-rays and pH aspirate, guideline-approved verification methods, were identified in 90.8% (544 of 599) of the reports. In 9.2% (55 of 599) of the reports, the use of non-recommended verification methods (e.g., insertion of air bolus/auscultation, were identified). Reports indicated that patients aged less than one year old experienced a higher percentage of non-recommended verification methods being used when compared to all other patients. Interviews with staff at three healthcare facilities discussed their approach to verifying NGT placement. Risk reduction strategies comprise using the guideline recommendations to verify NGT placement and avoiding the use of non-recommended verification methods.