Malpositioned nasogastric tube

Case contributed by Derek Smith


Head and neck cancer patient. Nasogastric tube (NGT) inserted for feeding. No aspirate gained following placement.

Patient Data

Age: 65 years
Gender: Male

The NG tube is following the right course but is sitting in the esophagus.

If advanced about 10 cm, it is likely to be in the stomach.

Bibasal atelectasis.

Despite advancing the tube, no aspirate obtained


This NGT is sufficiently advanced and passes along the midline with the tip well below the diaphragm. This will be safe for feeding.

Case Discussion

Recognizing correct nasogastric tube positioning is an important clincial skill. In this case, the NGT was on the right path but would not have been suitable in its initial position sitting in the esophagus. The patient was reimaged as although the tube was then in the correct position, no aspirate could be obtained and so a further check x-ray was performed.

Case courtesy of Dr H Hare.

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