Orogastric Tube Placement Guidelines

NHS Wales

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 for decades is actually being removed from guidelines due to evidence showing:
**Stethoscope confirmation of ORogastric (OG) tube placement by hearing air bubbles is NOT reliable:**
Studies cite:
1. **False positive rates up to 50%**: Air sounds can be heard over intestines or other areas.
2. **False negative rates up to 20%**: Correctly placed tubes might not produce audible air sounds.
3. **Variability in listener experience and technique**: Affects accuracy of assessment.
Current guidelines from:
- American Academy of Pediatrics (AAP)
- Neonatal Resuscitation Program (NRP)
- European Resuscitation Council (ERC)
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 (if available)**

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