I have read the AACN Practice Alert titled “Verification of Feeding Tube Placement”11 as well as the recent article by Metheny about preventing aspiration in patients with feeding tubes (“Preventing Respiratory Complications of Tube Feedings: Evidence-Based Practice,” July 2006: 360–369). My interpretation of these sources is that we should have an initial x-ray to confirm placement of any nasogastric tube prior to administering medication, feedings, and fluids.

Some of my colleagues look at these sources and infer a distinction between a small-bore “feeding” tube and a large-bore nasogastric tube (eg, Salem Sump). In making this distinction, they feel that x-ray confirmation is not necessary for large-bore nasogastric tubes; I don’t see that, however. I also notice that the AACN Procedure Manual for Critical Care does not clearly recommend x-ray confirmation for placement of these large-bore tubes.2...

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