To Determine Malpositioning of Small or Large Bore Gastric Tubes
Tube length has changed since previous measurement
(significance of change in measurement should be individualized to patient)
Is patient at high risk for malpositioning?
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
Assess back of patient’s throat
for obvious malpositioning
(e.g. coiling in the back of throat)
If unable to obtain aspirate:
o Adult patients: instill 20-30 mL bolus of air with a large syringe (30-60 mL)
before slowing drawing back
o Pediatric patients: instill 10-20 mL air bolus with a 20 mL syringe before slowing
1. Inspect the aspirate for color and consistency
a. Gastric juice is usually grassy green or clear and colorless
b. Small bowel juice is often bile-stained
c. Pleural fluid is typically watery and straw colored, with or without streaks of blood or
2. Determine a change in aspirate volumes (if being tube fed)
a. A large increase could mean a displacement from small intestine to stomach
b. Very little aspirate could mean displacement into esophagus
Discuss findings with provider/team.
If there is doubt of tube position in GI tract,
obtain an order for x-ray to verify proper placement.
It is prudent to obtain
an x-ray to confirm
Signs of Respiratory Distress?
(e.g. coughing, choking, cyanosis, inability to speak )
If clinically appropriate,
advance tube to original marking
and external length.
Inspect for color,
Created: Spring 2011, updated 12/2013; Contact person Élise Arsenault Knudsen
Maintenance of Enteral, NG & OG Tubes
► Before each use (tube feeding, medication administration,
water flush, etc):
Confirm tube marking (Hy-tape or nasal bridle) is in expected
location at the exit site.
► Every 8 hours:
Determine tube measurement: either by pre-printed cm
marking or by measuring the external length of the tube, from
the exit site to end of tube, excluding any valves.
Document in I/O/Drains flowsheet: tube marked and marking
as indicated on tube or external length of tube.
► If length of tube has changed since the previous measurement,
follow: Nursing Algorithm: To Determine Malpositioning of
Small or Large Bore Gastric Tubes.