Nasogastric tube positioning

Case contributed by Dr Derek Smith

Presentation

Unsafe swallow due to bulbar dysfunction - awaiting RIG placement.

Patient Data

Age: 75
Gender: Male
X-ray

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.

X-ray

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.

X-ray

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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Case information

rID: 33741
Published: 22nd Jan 2015
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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