A nasogastric tube is inserted in order for the client to receive inte

A nasogastric tube is inserted in order for the client to receive intermittent tube feedings. An ini-tial chest x-ray examination is done to confirm placement of the tube in the stomach.

After the x-ray confirmation, the most reliable method of checking for tube placement is for the nurse to:
1. Place the end of the tube in water and observing for bubbling
2. Auscultate while introducing air into the tube
3. Measure the pH of the secretions aspirated
4. Ask the client to speak

ANSWER

ANS: 3
After the x-ray confirmation, the next best method involves testing the pH of the feeding tube aspirate and observing the appearance of the aspirate. A properly obtained pH of 0 to 4 is a good indication of gastric placement. Placing the end of the tube in water and observing for bubbling is not an accurate method of checking for tube placement. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus can transmit a sound similar to that of air entering the stomach. Asking the client to speak as a method of checking for tube placement has a high degree of in-accuracy. There have been cases reported in which clients have been able to speak despite place-ment of feeding tubes in the lung.