After advancing an NG tube to the marked point, what is the next critical step?

• A. Rotate 90 degrees while advancing
• B. Verify placement and anchor to nose
• C. Flush with 20 mL saline
• D. Reinsert if resistance

Answer: (B)

Verifying placement and securing the tube to the nose is the next critical step. Once the marked point is reached, you must confirm that the tube tip is in the stomach (not the lungs or esophagus) to prevent feeding into the airway and avoid aspiration. This verification is typically done with radiographic confirmation as the most reliable method, with aspiration and pH testing providing supporting evidence if radiography isn’t immediately available. After placement is confirmed, the tube should be anchored to the nose to prevent displacement during use.

Rotating the tube while advancing can cause trauma and misplacement, and encountering resistance means you should stop and reassess rather than forcing advancement. Flushing with saline helps check patency, but it does not replace verifying proper placement before use.