From the Guidelines

Radiography is the primary imaging modality used to evaluate nasogastric (NG) tube or gastrostomy tube placement or obstruction.

Radiography is used to confirm proper position of an NG or OG tube before feeding is initiated 1
Water soluble contrast can be used to assess tube blockage or intraperitoneal leakage in gastrostomy tubes 1

Blind bedside gastric tube placement is often successful, but radiography is necessary to confirm proper position 1
Tube blockage can be caused by various factors, including hyperosmolar drugs, crushed tablets, and gastric mucosal overgrowth 1
Imaging modalities such as fluoroscopy or endoscopy may be used in certain situations, such as difficult tube placement or suspected obstruction 1

Enteral feeding tubes, including NG and gastrostomy tubes, are used in patients with esophageal obstruction from esophageal cancer who are potential candidates for resection and have concerns of malnutrition 1
Clinicians should be aware of the potential risks and complications associated with enteral feeding tubes, including abdominal wall tumor seeding and difficulty with subsequent gastric conduit formation 1

From the Research

Abdominal ultrasonography can be used to confirm the appropriate location of nasogastric tubes (NGT) in the stomach 2
X-ray checks can be used to confirm NG tube position, but may be associated with delays to feeding and drug treatment 3
Ultrasound-guided nasogastric feeding tube placement can be an effective method for confirming tube placement in critical care patients 4
Electromagnetic tracking can be used to confirm NG tube position, and may be more accurate than pH or X-ray methods 5
Point-of-care ultrasound (POCUS) can be used as an alternative imaging modality to confirm proper placement of NGTs and orogastric tubes (OGTs) in pediatric patients 6

Abdominal ultrasonography: allows for real-time visualization of the stomach and NGT, but may not be suitable for all patients 2
X-ray checks: can detect misplacement of NG tubes, but may be associated with delays to feeding and drug treatment 3
Ultrasound-guided nasogastric feeding tube placement: can be used to visualize the esophagus and stomach in real-time, but may not be suitable for all patients 4
Electromagnetic tracking: can provide accurate confirmation of NG tube position, but may not be widely available 5
POCUS: can be used to confirm NGT or OGT placement in pediatric patients, but may have limited sensitivity 6

Abdominal ultrasonography and ultrasound-guided nasogastric feeding tube placement can be used to confirm NG tube placement in critically ill patients 2, 4
X-ray checks can be used to confirm NG tube position in patients where other methods are not available 3
Electromagnetic tracking can be used to confirm NG tube position in patients where accurate placement is critical 5
POCUS can be used to confirm NGT or OGT placement in pediatric patients, and may reduce the need for routine X-ray confirmation 6