Presentation
Nasogastric tube check. Unsafe swallow following neck surgery. No aspirate gained from tube.
Patient Data
The nasogastric tube descends thorax in the midline but the tip is not below the level of the diaphragm.
The nasogastric tube descends thorax in the midline but the tip (yellow) is not below the level of the diaphragm (black dotted).
Case Discussion
This nasogastric tube is inappropriately sited.
It is at around the gastro-esophageal junction, so needs to be advanced further below the diaphragm before being safe for feeding. If feeding is commenced, the patient will likely aspirate.
These can be tricky to see, so change windowing on your imaging system to review this area if you cannot see the tip below the diaphragm.
If the tube has been passing safely in the midline, the tube could be advanced a few centimeters, or alternatively taken out and replaced.
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The case was originally contributed by Dr Derek Smith and is available here.