Guidelines for Verification of Gastric Tube Location in Adult Hospitalised Patients: A Systematic Review

Abstract

Background: Verification of correct gastric tube placement is a major patient safety issue. Guidelines recommend different procedures. Aim: To evaluate international guidelines for verifying correct gastric tube placement in adult hospitalised patients, identifying recommended practices and methodological quality. Study Design: Systematic review with searches conducted in Medline, CINAHL and guideline repositories until January 2024. Reference lists of identified articles were also screened. Guidelines on adult gastric tube placement based on a systematic literature search and/or a formal consensus process were included. Data extraction and quality assessments, using the AGREE-II tool, were conducted by two and four reviewers respectively. Results: Six guidelines from three countries were included. Radiographic confirmation is widely regarded as the gold standard for verifying gastric tube placement, especially when the position is uncertain, although bedside methods such as pH measurement, capnography and visual inspection are increasingly recommended. There is great variability regarding recommended bedside techniques, pH thresholds and routine monitoring practices. Marking the tube's exit site and routinely monitoring external length are universally recommended. Five guidelines recommend against the auscultation method either in general or at least with regard to its sole use. Methodological quality and evidence strength vary significantly across guidelines. Conclusions: While consensus exists on some aspects, variability in recommendations reflects inconsistent evidence bases. Most guidelines showed insufficient methodological quality. International standardisation and high-quality primary research are necessary. Relevance to Clinical Practice: This review synthesizes current guidelines on gastric tube placement, exposing methodological weaknesses, recommendation inconsistencies and unreliability of auscultation, identifying a critical information gap in clinical practice.