Hypersplenism in Cirrhosis
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X-ray confirmation is the gold standard for verifying initial nasogastric tube placement as it definitively shows tube position. Other methods have limitations: pH testing (gastric pH typically <5 but may be higher with medications); auscultation (air insufflation produces gurgling but can be heard with pulmonary placement); visual aspirate inspection (gastric contents often green, tan, or bloody but not definitive). After initial X-ray verification, nurses should: mark tube at exit point; check placement before each use by measuring external length and pH testing if possible; secure properly to prevent migration; and reassess with X-ray if displacement suspected or after coughing/vomiting. Small-bore feeding tubes are particularly prone to pulmonary placement with minimal symptoms. Complications of misplaced tubes: pneumothorax, pneumonia, medication/feeding administration into lungs. Policies typically require X-ray for initial placement and when doubt exists, with other methods for ongoing verification.
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