Nasogastric tube insertion and verification

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Saved on this device.

Target exams

Red flags

• Feeding or medicating through a nasogastric tube whose position has not been verified, or has been verified only by a deprecated method such as the whoosh test
• Treating an absent aspirate as proof that the tube is safely in the stomach and proceeding to feed
• Accepting a pH reading above 5.5 as gastric, when acid suppression, a recent feed or small-bowel migration has raised the pH and the tube may not be in the stomach
• Passing a nasogastric tube through the nose of a child with a base-of-skull or significant mid-face injury, where the tube can enter the cranium
• Forcefully re-passing a tube in a neonate who has just deteriorated, when the real problem is a traumatic pharyngo-oesophageal perforation that re-passing will worsen
• Failing to re-verify after the tube has been retaped, after retching or vomiting, after transfer or after extubation, on the false assumption that it cannot have moved

Life stages

Care settings

Clinical exam formats

Board mappings

• General and Community Paediatrics — practical procedures and patient safety in infants, children and young people
• Acute care — nasogastric tube insertion, verification and the prevention of harm
• Acute and critical care — procedural skills, verification and escalation in nasogastric tube management
• Patient safety and quality improvement — the Never Event framework and verification systems
• Clinical Applications — practical procedures: nasogastric tube insertion and verification
• Medical Sciences — gastrointestinal anatomy, gastric physiology and the basis of pH verification
• Patient safety — the Never Event of feeding an unverified nasogastric tube
• Short case and structured discussion of a child needing a nasogastric tube, including size, technique and verification
• Discussion of a nasogastric tube Never Event and its prevention
• 4. Patient management: practical procedures and the safe use of enteral access devices
• 7. Patient safety: procedural verification, documentation and the prevention of Never Events
• Neonatology and gastroenterology: nasogastric and orogastric tube placement
• Foundation of Practice (FOP) — gastrointestinal anatomy and procedural principles
• Applied Knowledge in Practice (AKP) — nasogastric tube verification, the pH threshold and the Never Event
• Communication — explaining tube verification and the safety check to a family
• History and management — a child needing a nasogastric tube
• General Pediatrics Content Outline — procedural skills and patient safety in nasogastric tube placement
• General Pediatrics Content Outline — Neonatology and Gastroenterology enteral-access content
• Universal Task 4: Management and Treatment of the child needing enteral access
• Patient Care — performing nasogastric tube insertion with appropriate verification and monitoring
• Patient Safety and Quality Improvement — verification systems, documentation and the prevention of Never Events
• Medical Knowledge — gastrointestinal anatomy and the physiology of gastric acidity
• Medical Expert — nasogastric and orogastric tube placement and verification in children
• Collaborator — interprofessional roles in verification and documentation
• Patient Safety — the Never Event of feeding an unverified tube