A doctor has asked the nurse to insert Ryle's tube and has also mentioned do not perform whoosh test to confirm the placement of the tube" How whoosh test is performed?

1. A

   Aspiration of the gastric content

2. B

   Push air in the tube and auscultate

3. C

   Flush with water through NG

4. D

   Perform Chest X-ray

Appeared in: AIIMS Delhi NO- 2019

Explanation

• The 'whoosh test' is a specific bedside procedure to estimate the position of a nasogastric tube.
• It involves the rapid injection of a bolus of air through the tube using a syringe.
• Simultaneously, the nurse auscultates (listens) with a stethoscope over the patient's epigastric (upper abdominal) area.
• Hearing a gurgling or 'whoosh' sound as the air enters is interpreted as a sign that the tube has reached the stomach.

Why Other Options Were Wrong

• Option A: This describes aspiration of gastric content, which is a different, more reliable method for checking tube placement, primarily through pH testing. It is not the whoosh test.
• Option C: Flushing with water is a procedure to ensure the tube is patent (not blocked) or to administer fluids. It is never used to confirm placement, as flushing a misplaced tube into the lungs can be fatal.
• Option D: A chest X-ray is the gold standard for confirming NG tube placement, but it is a radiological procedure, not the bedside auscultatory method known as the whoosh test.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Nasogastric (NG) tube placement verification methods helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Relying on the whoosh test is a significant patient safety risk. A false positive can lead to feeding or medication being delivered into the lungs, causing aspiration pneumonia, which can be fatal.
• Current evidence-based guidelines from organizations like the National Health Service (NHS) in the UK and various nursing bodies have condemned the use of the whoosh test as a primary confirmation method.
• The first-line check for NG tube placement at the bedside is testing the pH of the aspirate. A pH of 5.5 or below is a reliable indicator of gastric placement. An X-ray is the definitive gold standard.

How to Approach the Question

• First, identify the key term in the question: 'whoosh test'. The question asks for a definition of this specific procedure.
• Read the context: The doctor has ordered not to perform the test. This is a clue that it's likely an unreliable or outdated method, but it doesn't change the definition of the test itself.
• Analyze each option to see which one describes the 'whoosh test'.
• Option A describes aspiration. Option C describes flushing. Option D describes a chest X-ray. These are all related to NG tubes but are distinct procedures.
• Option B describes pushing air and auscultating (listening). This is the correct definition of the whoosh test.
• Therefore, select the option that accurately defines the procedure named in the question, even if the procedure itself is not recommended in practice.

Concept Tested & Keywords

• Concept Tested: Nasogastric (NG) tube placement verification methods
• Stem keywords: Ryle's tube, whoosh test, confirm placement
• Lead-in keywords: How
• Clinical cues: Doctor's order to not perform the whoosh test, indicating it is an outdated or unsafe practice.

Question ID

QdLAYgDGz1gPqwFX4CX3rt

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 668-670

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 54-56