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Confirming Nasogastric Tube Position

Indications:

  • Enteral access

    • Feeding​

    • Drug administration

  • Gastric decompression and drainage

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Complications from a misplaced NGT can have significant clinical implications so placement must be confirmed by CXR before commencement of use!

  • Any other method of placement confirmation is NOT adequate!

  • If in doubt, consult with ICU registrar/consultant

    • The radiology registrar may also be consulted for advice regarding position​

Confirming Placement:

  1. NGT descends through the mediastinum in the midline

  2. The tip lies below the diaphragm

  3. The tip lies at least 10cm distal to the gastro-oesophageal junction OR the side-port is visualised and lies in the stomach

    • The nasogastric tubes commonly used in our ICU are dual lumen with a side-port that lies a few centimetres proximal to the tip​

    • The side-port is visible as a small gap in the radio-opaque line of the nasogastric tube on CXR (see below)

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Confirm Absence of Misplacement:

  1. NGT is not curled in the mouth or oesophagus

  2. NGT is not located in or follow the course of any bronchi

    • Absence of coughing/respiratory distress is not evidence of oesophageal placement​

  3. No evidence of pneumothorax

Black arrow shows the side-port

Images from radiologymasterclass.co.uk

       Author: Dr. Kirsty O'Keefe, Peer Reviewer: Dr. Irma Bilgrami Date: 22/03/20

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