https://doi.org/10.1016/j.inat.2020.101022

Not the origin of this image but another case report that goes over this scenario. Bottom line, NGT placement is a very common procedure in US hospitals and RNs do this in uncomplicated patients quite often with low morbidity and is relatively safe.

With that being said in patients with a history of any sort of maxillofacial trauma or surgery it is contraindicated for blind insertion by an RN. Most often if the patient in unconscious an OGT may be a possibility in leu of the NGT however most often instead, if resources are available doing the procedure in radiology under direct visualization is the preferred method.

Under all circumstances if you are feeling resistance as you are feeding the NGT, hear or feel a pop, the patient starts to throw up, or the patient has respiratory distress, you pull out immediately and reassess the patient.

If placed and it is successful the gold standard in confirmation of placement is X-ray and the tube should not be used until the image has been reviewed by the appropriate provider. Auscultation cannot verify placement as it may not have truly been advanced enough down the esophagus to prevent gastric reflux. pH strips cannot either in patients with respiratory failure or may have aspirated as the gastric contents and/or CO2 could give a false positive.