Certified Pediatric Nurse (CPN)

To verify the placement of a nasogastric tube for charcoal administration, what is the best practice?

1. Instill air and auscultate over the upper left epigastrium

2. Assume correct placement if there is no choking or decreased O2 saturation

3. Instill air and auscultate the upper chest for lung placement

4. Aspirate contents and verify that the pH is less than 6

The correct answer is: Aspirate contents and verify that the pH is less than 6

Verifying the placement of a nasogastric (NG) tube is critical to ensure safe administration of substances such as activated charcoal. One of the best practices for confirming correct placement involves aspirating the contents of the tube and checking the pH. A pH of less than 6 indicates that the tube is most likely in the stomach because gastric contents typically have a more acidic pH compared to other areas such as the intestines or the lungs. This method is preferred because it provides a direct assessment of the tube's position based on the actual contents retrieved. It minimizes the risk of complications such as aspiration, which can occur if the tube is mistakenly placed in the lungs instead of the stomach. Utilizing pH testing is a reliable and effective technique supported by clinical guidelines for NG tube placement verification. Other methods, such as instilling air and auscultating over the abdomen or chest, carry a higher risk of false positives due to the potential for air to enter the lungs, leading to incorrect assumptions about tube placement. Relying solely on clinical signs like choking or changes in oxygen saturation is insufficient and could be dangerous, as they do not provide definitive evidence of proper tube placement. Therefore, aspirating contents and verifying pH is the safest and