Ultrasonography-Guided Nasogastric Tube Placement and Verification: A Standardized Nursing Protocol

This protocol presents a standardized, evidence-based nursing approach for ultrasonography-guided nasogastric tube (NGT) placement and verification in adult patients. The method was developed from a scoping review of 29 studies that examined clinical indications, technical procedures, and decision-making strategies for point-of-care ultrasonography (PoCUS) in NGT confirmation. Across the literature, ultrasonography consistently emerged as a safe, rapid, radiation-free tool for real-time visualization of the tube within the esophagus and stomach. While chest radiography remains the conventional reference standard, the cumulative evidence demonstrates that ultrasound reduces delays in confirming placement and initiating enteral nutrition-an outcome of particular relevance in critically ill or nutritionally vulnerable populations. The protocol describes key technical components, including optimal patient positioning, selection of cervical and epigastric sonographic windows, and the use of linear and convex transducers for accurate visualization. It also integrates direct and indirect verification techniques, such as hyperechoic tube identification and dynamic fogging. Overall, this protocol aims to enhance patient safety, standardize clinical practice, expand nursing autonomy, and support broader adoption of PoCUS for gastric access verification.