Confirmation of Nasogastric Tube Placement

I have read the AACN Practice Alert titled “Verification of Feeding Tube Placement”¹ 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 To me, the danger in such an approach is that large-bore tubes...