Orogastric Tube and Post Pylorics Tube Placement Guidelines

NHS Wales: Guidelines for the insertion of orogastric and nasogastric enteral feeding tubes in the Neonatal/ Maternity Unit

https://wisdom.nhs.wales/health-board-guidelines/swansea-bay-neonatal-postnatal-ward/neonatal-file/chapter-2-insertion-of-orogastric-and-nasogastric-feeding-tubes-abmu-neonatal-guideline-v2019-1-pdf/&ved=2ahUKEwipysD2vdONAxVFRuUKHbvlFfAQFnoFCJUBEAE&usg=AOvVaw1Al4nJWaaosji-xXU9XEeo

Add to it:

Lubricate with normal saline, or lubricant 

Flush with normal saline or water after feeds to ensure patency and bacterial colonization 

A common practice to confirm OG placement by hearing air sounds pushed via syringe is removed from guidelines due to evidence showing:

**Stethoscope confirmation of Orogastric (OG) tube placement by hearing air bubbles is NOT reliable:**

Research shows:

1.  Air sounds can be heard over intestines or other areas.

2. Correctly placed tubes might not produce audible air sounds.

3. Variability in listener experience and technique affects accuracy of assessment.

Current guidelines recommend confirmation of OG tube placement using:

1. **Aspiration of stomach contents**

2. **Measurement of pH of aspirate** (should be acidic)

3. **Chest X-ray (if clinically indicated or for larger tubes)**

4. **Visualization of tube in stomach via ultrasound **