Editing Nursing Skills and Procedures (section)

=== Verifying placement ===
Radiographic confirmation is the gold standard after initial blind insertion and before the first use of a small-bore tube. Before each feeding or medication administration thereafter, the nurse aspirates gastric contents and checks pH. A pH of about 5.5 or lower supports gastric placement, although acid-suppressing medications raise gastric pH and reduce the reliability of this test. The nurse also measures the external tube length and compares it with the documented insertion mark. Auscultation of an air bolus over the epigastrium, the "whoosh" test, is not reliable and is not acceptable practice. Any new coughing, choking, voice change, or falling oxygen saturation demands that feeding stop and placement be reverified.