Research Article| Volume 63, P72-77, March 2022

Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children – A follow-up study

Published:November 08, 2021DOI:


      • Nasogastric tube placement verification
      • Evaluation methods for nasogastric tube placement
      • Best practice for nasogastric tube placement
      • Hospitalized children with nasogastric tubes
      • Evidence based practice



      Nasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events.


      A study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change.


      Respondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s).


      Comparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification.

      Application to practice

      This study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.


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        • AACN Practice Alert
        Verification of feeding tube placement (blindly inserted).
        American Association of Critical Care Nurses, Aliso Viejo, CA2020
        • Aguilar-Nascimento J.E.
        • Kudsk K.A.
        Clinical costs of feeding tube placement.
        Journal of Parenteral and Enteral Nutrition. 2007; 31: 269-273
        • Bourgault A.M.
        • Powers J.
        • Aguirre L.
        • Hines R.B.
        • Sebastian A.T.
        • Upvall M.J.
        National survey of feeding tube verification practices: An urgent call for auscultation deimplementation.
        Dimensions of Critical Care Nursing. 2020; 39: 329-338
        • Brown C.
        • Wickline M.A.
        • Ecoff L.
        • Glasser D.
        Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center.
        Journal of Advanced Nursing. 2009; 65: 371-381
        • Child Health Patient Safety Organization
        Blind pediatric NG tube placements continue to cause harm.
        Child Health Patient Safety Organization, Inc., Overland Park, KS2012
        • Hanrahan K.
        • Wagner M.
        • Matthews G.
        • Stewart S.
        • Dawson C.
        • Greiner J.
        • Williamson A.
        Sacred cow gone to pasture: A systematic evaluation and integration of evidence-based practice.
        Worldviews on Evidence-Based Nursing. 2015; 12: 3-11
        • Helfrich C.D.
        • Rose A.J.
        • Hartmann C.W.
        • van Bodegom-Vos L.
        • Graham I.
        • Wood S.
        • Aron D.
        How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution.
        Journal of Evaluation in Clinical Practice. 2018; 24: 195-205
        • Irving S.Y.
        • Rempel G.
        • Lyman B.
        • Sevilla W.M.
        • Northington L.
        • Guenter P.
        Pediatric nasogastric tube placement and verification: Best practice recommendations from the NOVEL project.
        Nutrition in Clinical Practice. 2018; 33: 921-927
        • Kemper C.
        • Haney B.
        • Oschman A.
        • Lee B.
        • Lyman B.
        • Parker L.
        • Brandon D.
        Acidity of enteral feeding tube aspirate in neonates: Do pH values meet the cutoff for predicting gastric placement?.
        Advances in Neonatal Nursing. 2019; 19: 333-341
        • Lipman T.O.
        • Kessler T.
        • Arabian A.
        Nasopulmonary intubation with feeding tubes: Case reports and review of the literature.
        JPEN Journal of Parenteral and Enteral Nutrition. 1985; 9: 618-620
        • Lyman B.
        • Kemper C.
        • Northington L.
        • Yaworski J.A.
        • Wilder K.
        • Moore C.
        • Irving S.
        Use of temporary enteral access devices in hospitalized neonatal and pediatric patients in the United States.
        Journal of Parenteral and Enteral Nutrition. 2016; 40: 574-580
        • Meert K.
        • Caverly M.
        • Kelm L.M.
        • Metheny N.A.
        The pH of feeding tube aspirates from critically ill infants.
        American Joint Committee on Cancer. 2015; 24: e72-e77
        • Metheny N.A.
        • Pawluska A.
        • Lulic M.
        • Hinyard L.
        • Meert K.
        Testing placement of gastric feeding tubes in infants.
        American Association of Critical Care Nurses. 2017; 26: 466-473
        • Metheny N.A.
        • Stewart B.J.
        • Mills A.C.
        Blind insertion of feeding tubes in intensive care units: A national survey.
        American Joint Committee on Cancer. 2012; 21: 352-360
        • National Health Service
        Nasogastric tube misplacement continuing risk of death and severe harm.
        in: Patient safety alert. 2016 (NHS/PSA/RE/2016/006. Accessed July 24, 2019)
        • Patient Safety Movement Foundation
        Actionable patient safety solution #15—Nasogastric tube (NGT) placement and verification.
        (Accessed July 2, 2019)
        • Patient Safety Movement Foundation
        (Accessed July 24, 2019)
        • Point of Care Testing
        • Joint Commission International
        (Accessed 3/24/2021)
        • Prusaczyk B.
        • Swindle T.
        • Curran G.
        Defining and conceptualizing outcomes for de-implementation: Key distinctions from implementation outcomes.
        Implementation Science Communications. 2020; 1: 1-10
        • Quandt D.
        • Schraner T.
        • Bucher H.U.
        • Mieth R.A.
        Malposition of feeding tubes in neonates: Is it an issue?.
        Journal of Pediatric Gastroenterology and Nutrition. 2009; 48: 608-611
        • Rogers E.M.
        Diffusion of innovations.
        5th ed. Free Press, New York, NY2003
        • Sorokin R.
        • Gottlieb J.E.
        Enhancing patient safety during feeding tube insertion: A review of more than 2000 insertions.
        Journal of Parenteral and Enteral Nutrition. 2006; 30: 440-445
        • Wallace S.C.
        Data snapshot: Complications linked to iatrogenic enteral feeding tube misplacements.
        Pennsylvania Patient Safety Advisory. 2017; 14 (Accessed July 24, 2019): 1-5