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Reflective journal nursing

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A nasogastric tube is inserted to a patient for medical administration, feeding and for drainage of gastric content, it is very commonly be used in the ward, especially for critically ill patients in acute care ward and the Intensive Care Unit (ICU). And according to our previous knowledge, we have learnt several methods to check the correct placement of the nasogastric tube inserted, which includes using the pH paper to test the acidity of the gastric content aspirated. And the other ways are using chest X-Ray in the ward,this is also the most reliable method to assure the correct placement of NG tube. And lastly is by auscultation (listening to the pop-sound of the stomach when air is injected through the NG tube).

The journal article our group has chosen is about the review (based on evidence and research) on the best way to confirm the correct placement of nasogastric tube. It is necessary to find out some effective and certain ways to confirm the correct placement of the NG tube as incorrect placement of the NG tube in the respiratory tract will cause serious effect to patient, patient may suffer from pneumonia or even fatality. The main aim of this journal article is to find out the best practice to check the correct placement of a NG tube in order to avoid these kind of situation.

Apart from the three methods we have learnt, the journal article introduces several methods in addition, comprising both reliable and non-reliable ones. Previously, I have learnt certain methods to be used when checking the correct placement of the NG tube, but never studied the other side in details about why are those unreliable methods should not be applied to patients. The authors of this article have put the similar type of practices to make a comparison, which is very clear to know the merits and limitations of each practice.

I am now able to distinguish which ways are beneficial and which are not favourable to a patient. For example, comparing litmus paper and pH indicator, although both of them are used to testing the acidity of the aspirate, pH indicator provide a defined pH range. In the contrary, blue litmus paper can only show whether the content is acidic or alkaline. As both content are acidic, it is difficult to distinguish whether the content is from respiratory or GI tract. Blue litmus paper is thus not recommended to be used.

Besides, the journal article also mentioned the reason for eliminating the use of bubbling test in the ward. It used to be a common practice in the ward. Bubble is being observed during expiration. When there are bubbles exist, it means that NG tube has been placed to the respiratory tract. However, it neglected the possibility of the existence of stomach air, it can also create bubbles when testing. It seems that there is no specific method that is totally perfect for checking the placement of NG tube, even for chest x-Ray. In the Intensive Care Unit (ICU), because patients are critically ill, feeding will pose a higher risk to them. Thus, it is necessary to use chest x-Ray before each time of feeding.

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