Institutional policies

Tube placement

Confirmation of placement before first use

Reconfirmation of NGT placement after initial use

Practices that should NEVER be used

The following non-evidence based practices are misleading and should never be used as methods to verify NGT placement:

Technology Plan

Methods of NGT placement confirmation reported in a recently published literature review1 are listed below. New literature and/or options may exist, please send information on any additional technologies, along with appropriate evidence, to info@patientsafetysummit.org
The AACN2 recommends using 2 or more bedside methods to predict tube location during insertion, before feeding, at four hourly intervals after feeding has started or if there is any interruption in feeding.

Supplementary checks on NGT placement (NOT to be used as confirmation of correct placement):

Methods with limited indication or unclear benefit requiring further research:

Metrics

Topic

Misplacement of Nasogastric or orogastric tubes 

Outcome Measure Formula

Numerator: Number of misplaced nasogastric or orogastric tubes
Denominator: Total number of placed nasogastric or orogastric tubes
*Rate is typically expressed as numerator/denominator * XXXX

Metric Recommendations

Direct Impact:
Lives Spared Harm:
Data Collection:  
In an ideal healthcare system where an integrated electronic health record system exists, it would be possible to a capture population based incidence of nasogastric/orogastric feeding tube misplacements as a percentage of all tubes placed.  In addition to quantitative data on misplacements, qualitative data on patient outcomes could also be captured by the mortality and specific morbidity rates.  At the current time, there is no mandate for healthcare institutions to report misplacements, although many do participate in a Patient Safety Organization that would track such events.  Without a mandate from a regulatory agency to report nasogastric/orogastric feeding tube misplacements it is not possible to have accurate metrics for this safety initiative.