What is the best method to assess safe placement of an NG tube?

Obtaining radiographic confirmation is the best method to assess safe placement of a nasogastric (NG) tube. This method provides a definitive visualization that confirms the tube's location in the stomach or, ideally, further down the gastrointestinal tract if that aligns with the procedure's intent. Radiography serves to effectively rule out any misplacement in the trachea or another unintended location, significantly decreasing the risk of complications such as aspiration pneumonia.

While clinical assessment of tube length can provide an initial idea of whether the tube is placed correctly based on standard measurements, it cannot confirm actual location within the body. Checking gastric residuals is used for assessing tube function and gastric emptying but does not confirm placement; the NG tube could still be misplaced. Measuring the pH of gastric contents can give some indications about the likelihood of proper placement—such as a pH less than 5 typically indicating gastric placement—but it is not as definitive as radiographic confirmation. Therefore, radiographic confirmation stands out as the safest, most reliable method for ensuring correct NG tube placement.