What is the most reliable method to confirm nasogastric tube placement after insertion?

• A. pH aspirate
• B. Chest X-ray
• C. Auscultation of air
• D. Length measurement

Answer: (B)

Chest X-ray confirms nasogastric tube placement by providing a direct view of the tube’s path and the tip’s location, ensuring the tip is in the stomach and not in the esophagus or lungs. This visual confirmation is the most reliable way to prevent dangerous misplacements that could lead to aspiration or pneumothorax, making it the standard practice before initiating feeds or medications through the tube.

Other methods have limitations. Checking aspirate pH can suggest gastric content, but it isn’t definitive because many factors—such as antacid use, buffering, or inability to obtain aspirate—can skew results. Listening for sounds after injecting air is unreliable because sounds can be misleading and can occur even with misplacement. Measuring the tube length at the nostril only estimates position and can’t detect migration after placement.