Assessing NG tube position (basic)

Dr Jeremy Jones et al.
This is a basic article for medical students and other non-radiologists

NG tube placement is commonly assessed using a chest radiograph although local protocol may dictate that pH assessment of NG aspirate be used in the first instance to confirm position of the NG tube.

There are recognised landmarks to look for on chest radiograph which can help you confirm NG tube placement:

  • tube descends the thorax in the midline
  • tube bisects the carina
  • tube crosses the diaphragm in the midline
  • the tip sits below the diaphragm

By following these guides, the likelihood of the tube following the path of an airway rather than the oesophagus is low.

Most feeding tubes should be visible on a plain film without a guidewire. If you have trouble seeing the landmarks, you can change the windowing of the radiograph, discuss with a senior or consider repeating the film (in discussion with your radiographers).

In some cases, larger patients will be better examined as a supine chest rather than erect; this is due to the distribution of fat being more widespread when laying flat (only when purely for nasogastric tube).

Correct interpretation is important to get right because of the potential consequences if the tube is misplaced.

Medical student imaging approach
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Article Information

rID: 31405
Section: Approach
Synonyms or Alternate Spellings:
  • Assessing NG tube position (basic)
  • Assessing NGT position (basic)

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    Correct placement of nasogastric tube
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    Annotated image of correct placement
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    NG tube looped around carina
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    Correct placement
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