Four hours. Six learners, two insertion stations, three attempts each. The validation checklist is published in full below, and most people who fail it fail after the tube is already in.
Passing a nasogastric tube is not the difficult part. Nurses learn the insertion quickly, and most learn it well. The harm happens afterwards, in the ninety seconds between the tube being in and the tube being used, when somebody decides it is in the stomach on evidence that never proved anything.
A tube that has passed into the airway can be aspirated. It can look right, sound right, and produce fluid. Feed it, flush it, or put a crushed tablet down it and the injury is immediate and sometimes fatal. This course is built backwards from that moment.
Every one of those five has been taught as confirmation at some point, and the first two are still in circulation. Half a day here is spent making sure you never use any of them again, and can say out loud why each one fails.
| Min | Module | What happens |
|---|---|---|
| 20 | Verify before you use | The golden rule, and the two errors that actually injure patients: auscultation treated as confirmation, and NEX treated as proof. We open on the error rather than the anatomy, deliberately. |
| 30 | Should this tube go in at all | Indications: enteral nutrition, gastric decompression, gastric aspiration. Pre-insertion assessment, the contraindications, tube selection and French sizing. |
| 25 | Measuring, and what measuring is worth | NEX, nose to earlobe to xiphoid, measured hands-on and dry on a partner. Then the evidence that it underestimates, and what follows from that. |
| 35 | The sequence, demonstrated | Insertion demonstrated slowly and narrated, with each stop-and-reassess trigger called out as it arrives rather than listed afterwards. |
| 10 | Break | |
| 45 | Supervised practice | Manikin insertion. Two stations, three attempts each, an educator beside you correcting during rather than after. The longest block of the day. |
| 30 | Confirmation | pH testing of gastric aspirate and radiographic confirmation. The five unreliable methods taken one at a time. Hands-on reading of pH strips against prepared samples, then documentation. |
| 20 | Securing, monitoring, complications | Migration after vomiting, retching, coughing and movement. The complications, and which ones the nurse at the bedside is expected to recognise. A worked case, discussed as a group. |
| 25 | Skills validation | Performed under observation against the checklist below, which you receive when you book. |
| 240 | Total | Four hours |
Most training providers describe their assessment. Here is ours, complete, before you have paid anything. You are given the same document when you book, because an assessment you cannot see in advance is a test of nerve rather than of competence.
What this course rests on. The teaching is anchored to published guidance rather than local habit. The American Association of Critical-Care Nurses publishes a practice alert on initial and ongoing verification of feeding tube placement in adults, which is the lead reference for the verification block. The American Society for Parenteral and Enteral Nutrition publishes safe practice recommendations for enteral nutrition therapy covering placement verification, and runs a dedicated project on new methods of verifying enteral tube location. In the United Kingdom, NHS England and the former National Patient Safety Agency treat a misplaced nasogastric tube used for feeding as a never event, and the British Association for Parenteral and Enteral Nutrition publishes on the same problem. That body of work is the most detailed anywhere on this specific error.
Where your facility's own protocol differs from anything taught here, your facility's protocol governs, and we say so during the session rather than leaving you to find out later. The pH threshold your facility accepts, and who is permitted to read and document a confirmatory radiograph, are set locally and vary. We teach you to find and follow your own policy, not to carry ours into your workplace.
These are free and take about twenty-five minutes. Arriving having read them means the session is spent on your hands and your reasoning rather than on definitions.
These three are a sequence rather than a menu. Each one assumes the one before it.
Before any tube, the assessment that tells you whether this patient can protect an airway. NG competency assumes it.
You are here. Insertion, and the confirmation block that decides whether the tube may be used.
The complication after the tube is in. Trends, escalation, and turning recognition into a call that changes the outcome.
