Learning Objective #1: Describe an evidence-based protocol for verifying placement of nasogastric tubes

Learning Objective #2: Discuss the validity and reliability of current strategies for bedside monitoring of nasogastric tube placement

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Purpose: Numerous adverse events including aspiration, pneumonia, and death have been associated with improperly positioned gastric tubes. This presentation addresses an integrative review of the research designed to determine an evidence-based, clinically relevant and reliable approach to providing care to weighted and non-weighted gastric tubes used for decompression or instillation of medications or nutritional supplements in an academic medical center. Methods: Clinical nurse specialists representing a variety of specialties and practice settings conducted an extensive review of the research and related literature. They also developed an evidence-based protocol designed to clarify procedures for insertion, verification and monitoring of gastric tubes. Efforts focused on evaluating myths and rituals as well as translating research findings into practice. The guideline was simplified and presented in a flow sheet format to support staff nurses in their efforts to provided evidence-based practice. Implementation of these guidelines was facilitated by providing staff nurses with easy-to-follow clinical guides and self-learning packet. Results: In consultation with interdisciplinary team members, clinical experts agreed that for the most acutely ill patients, verification by x-ray serves as one of the most valid and reliable ways to determine tube placement upon insertion of either a weighted or non-weighted tube. Ongoing monitoring requires verification by pH testing and determination of the length of the tube, characteristics of any aspirated fluids, the patient's risks for displacement of the tube. All of these conditions may necessitate repeat x-ray evaluation. Certain situations place patients at higher risk for aspiration and require further assessment and verification of placement. Conclusions and Implications: Other than x-ray, no accurate bedside procedure exists for determining gastric tube placement that can be consistently utilized in all clinical situations. Utilization of evidence-based guidelines can assist clinicians to make appropriate assessment decisions when caring for patients with weighted or non-weighted gastric tubes.