Almost all patients on ACCU will have a naso or oro-gastric tube inserted for feeding. Most of the insertions will be performed by a nurse. Before initiating feeding, the position of the tube will be checked by testing the pH of a sample aspirated from it. If no aspirate can be obtained, ask the nurse to try again after turning the patient to the left, injecting 10-20 mL of air, performing mouth care and waiting for 15-30 minutes or so. If there is still no aspirate, or the pH is greater than 5, you will need to order a chest radiograph. Make clear on the request it is to check the position of a NG or OG tube.
On ACCU, trainees are authorised to confirm the position of a gastric tube on CXR, provided they have successfully undertaken training on the following site: http://bold.bartshealth.nhs.uk (you will need your ‘assignment number’ from your payslip to register). If you have not completed the training, or you are in doubt about the tube position, ask the ACCU consultant or a radiologist to review the film. Document your conversation.