Here’s an uncomfortable truth about how nasogastric tubes are checked — and it applies wherever you practice.

The standard checks — aspirate pH testing, and a chest X-ray when there’s doubt — happen after the tube is placed. They’re designed to catch a tube that’s gone into the airway before feeding starts.

But a 2024 review in the International Journal of Risk & Safety in Medicine makes a sharp point: by the time those checks happen, some of the harm may already be done. The author argues that current post-placement checks “detect misplacement too late to prevent most pneumothoraces,” which account for the large majority of lung complications during tube placement.

In other words, the focus has been on catching the error at the finish line — when the bigger opportunity may be to spot the tube heading the wrong way during placement.

That’s the case for an in-procedure check, like detecting CO₂ (a sign the tube tip is potentially in the airway) before the tube is fully advanced.

It’s a shift in thinking: from “is it safe to feed?” to “is it safe to keep going?” Know before you go!

Source: Taylor SJ, Feeding tube safety: National guidance ignores the ‘elephant in the room’, Int J Risk Saf Med, 2024.