Chest X-ray - Tubes
NG Tubes - Complications

Key points

  • Incorrect positioning of a nasogastric tube is common
  • Passing food or medication via a NG tube into the airways carries a high risk of mortality

When placing a nasogastric tube it is important to appreciate that its tip may not be positioned correctly in the stomach and may be aspirated rather than swallowed.

Passing food or medication via a NG tube into the airways carries a high risk of mortality. For this reason patients are not given food or medication via a nasogastric tube until its position has been determined, preferably by aspiration of gastric fluid through the tube.

NG tube misplacement - Looped

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NG tube misplacement - Looped

  • The tube passes below the level of the carina and does not follow the course of the right or left bronchi
  • The tube is, therefore, in the oesophagus and has not been inhaled
  • The tube is looped back on itself so its tip is located in the upper oesophagus
  • Feeding via a tube in this position would risk aspiration of the feed into the lungs
  • The tube must be repositioned

Tube misplacement in right main bronchus

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Tube misplacement in right main bronchus

  • The tube follows the course of the right main bronchus
  • Its tip is projected over the lower zone of the right lung
  • The NG tube has been inhaled rather than swallowed
  • The tube must be removed and repositioned

Tube misplacement in proximal stomach

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Tube misplacement in proximal stomach

  • This tube has reached the stomach but it is not in a safe position for feeding
  • If left in this position there is a risk of it being displaced proximally when the patient changes posture
  • For safe positioning it is recommended that a NG tube tip is located at least 10 cm distal to the gastro-oesophageal junction (green target area)

Tube misplacement in duodenum

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Tube misplacement in duodenum

  • The gastroduodenal junction is located just to the right side of the midline (spine indicates midline)
  • To ensure the tube is not in the duodenum, its tip is ideally placed more proximally in the stomach to the left of the midline
  • For feeding into the stomach this tube should be withdrawn and its position confirmed either by a further attempt of aspiration of gastric fluid or by repeating the X-ray