After inserting a nasogastric tube, what would be the nurse's priority action prior to starting the first tube feeding?
a. Auscultate bowel sounds over the abdomen.
b. Aspirate gastric contents and obtain a pH reading.
c. Obtain radiographic verification (x-ray).
d. Mix the feeding with water for the first feeding only.
C
Radiographic (x-ray) verification is the only reliable method for confirming tube placement; it must be performed before the first feeding is administered. All feeding tubes contain markings that can be detected by radiographic films. Reliable bedside assessment is necessary following the initial x-ray verification and is used prior to feedings because even when the tube is initially placed correctly in the stomach/intestines and verified by x-ray, it may move upward. However, no bedside method alone is reliable. Feeding tube placement can be checked by testing the pH of the aspirate in combination with other methods; however, this is not the most reliable indication of proper placement prior to a first feeding. Auscultating bowel sounds does not provide any reliable information related to tube placement, although it is an indicator of intestinal motility. For an initial feeding, the prescriber may order the feeding to be mixed with water to assess the patient's tolerance of the feeding. Nevertheless, tube placement must be verified prior to feeding.
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