Bronchial placement of nasogastric tube

Case contributed by UoE Radiology

Presentation

Stroke patient - nasogastric tube confirmation for unsafe swallow.

Patient Data

Age: 50 years
Gender: Female

Incorrectly positioned nasogastric tube - the tube enters rotated film in midline, but the tube does not cross the carina, following the course of the right bronchus.

This should be removed as soon as able, and must not be used for feeding.

Annotated image

Incorrectly positioned nasogastric tube - the tube enters rotated film in midline, but the tube (yellow) does not cross the carina (blue), following the course of the right bronchus.

Case Discussion

This is an example of one of the main risks with nasogastric tube insertion.

Due to the close relation of the openings of the esophagus and the trachea, it is far too easy for NG tubes to pass into the respiratory system.

Remember too that on a CXR, the lung bases sit well below the projected level of the diaphragm so it is not safe to use unless the tube travels down the midline.

If this is not quickly recognized, and the tubes are used for medication or feeding, the patient is at significant risk of aspiration, pneumonitis and death.

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Case (rID 33746) originally contributed by Dr Derek Smith and available here.

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