Nursing Algorithm: Initial Placement Verification
for Nasogastric (NG) & Orogastric (OG) tubes
Was NG/OG tube blindly inserted?
(e.g. placed by a health care professional without
radiological technology or in Operating Room)
Signs of respiratory distress?
(e.g. coughing, choking, cyanosis, inability to speak)
Obtain x-ray with complete
visualization of the length of
the tube –
per provider order
Request x-ray read and
confirmation of placement
from ordering provider/team
Reposition as indicated;
determine need to
1. Mark tube at exit site with waterproof tape (e.g. Hytape).
Document in “tube marked” row.
2. Determine tube measurement. Document the length of
the tube after placement is verified.
a. Marking as indicated on tube: document the pre-printed
number (cm marking) closest to the exit site.
b. External length of tube: measure from the exit site (tip of
nares or at lips) to the end of tube, excluding any valves.
of tube site verification
(e.g. Tube’s LDA, OR note,
previous x-ray report, PACU
If documentation is not found,
consult with provider/team to
either collectively identify
documentation or obtain an
order for x-ray to verify
Patients at high risk for tube malpositioning include
Are unconscious or heavily sedated
Have an endotracheal tube or tracheostomy
Are uncooperative during tube insertion
Are agitated/ uncooperative during course of tube
Have depressed gag and cough reflexes
Exhibit confusion or are debilitated
Have episodes of forceful coughing and/or vomiting
Have craniofacial trauma (place tube under fluoroscopy
Upon Placement of NG or OG Tube
► Verify Placement per Nursing Algorithm: Initial
Placement Verification for NG/OG Tubes
► Add tube as LDA on “I/O/Drains” Flowsheet
► Mark the tube at the exit site with pink Hy-tape
► Determine tube measurement – either by pre-printed
cm marking or measuring the external length of the
tube, from exit site to end of tube, excluding any valves.
► Document every 8 hours:
What is the purpose of the
Instillation of tube feeding,
fluids or medications
Created: Spring 2011, updated 12/2013; Contact person Élise Arsenault Knudsen
All blindly inserted gastric tubes used for instilling feeding, fluids, or medications must
have radiographic (x-ray) confirmation before use, regardless of insertion reason.
Example: NG tube initially placed for decompression, later is needed for medication administration and tube feeding;
an x-ray must confirm placement before administration of medication and/or feeding.