Nasogastric tube positioning

Case contributed by Derek Smith


Unsafe swallow due to bulbar dysfunction - awaiting RIG placement.

Patient Data

Age: 75
Gender: Male

Initial chest film (no aspirate gained)


Tube descends in midline but tip only just at level of esophageal-gastric junction.  Advance a few centimeters before commencing feeding.

Cardiomegaly, sternal wires and biventricular pacemaker noted.

Follow up film


Tube tip well below diaphragm - beyond limits of this film, is it at an appropriate length?

Right mid-zone opacification progressing from previous imaging.


Tip again retracted - advance prior to feeding.

Right midzone opacification unchanged from previous imaging.

Case Discussion

This case illustrated how mobile nasogastric tubes can be - especially with older patients.  These are just a selection of this patient's multiple CXRs to confirm tube positioning over his admission prior to getting a permanent feeding solution.

Appropriate documentation of length of insertion on the ward is useful when re-positioning these tubes.

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