From the Guidelines
A chest x-ray is the recommended imaging method for confirming nasogastric (NG) tube placement. Specifically, an anteroposterior (AP) chest x-ray that includes visualization of the upper abdomen is considered the gold standard verification method, as it allows clinicians to confirm that the NG tube has passed through the esophagus and into the stomach, rather than being inadvertently placed in the lungs or other incorrect locations 1. This type of x-ray should show the tube passing below the diaphragm and the tip positioned in the stomach, ideally in the body or antrum of the stomach.
Key considerations for ordering the correct x-ray include:
- Ensuring the x-ray includes the upper abdomen to visualize the stomach and confirm NG tube placement
- Using an anteroposterior (AP) view to provide a clear image of the NG tube's course
- Verifying the NG tube's position below the diaphragm and in the stomach to prevent complications
While other methods such as pH testing of aspirate, auscultation, or observing for bubbling when the tube is placed underwater exist, these are considered less reliable and should not replace radiographic confirmation, especially for initial placement, as misplaced NG tubes can lead to serious complications including pneumothorax, pneumonia, or aspiration if feedings or medications are administered through an improperly positioned tube 1.
From the Research
Recommended X-ray for Confirming NG Tube Placement
To confirm the placement of a nasogastric (NG) tube, the following types of x-rays are recommended:
- Abdominal radiograph: This type of x-ray is used to confirm gastric placement of the NG tube tip 2.
- Chest radiograph: This type of x-ray is universally accepted as the method of choice to confirm correct positioning of an NG tube, but it has some limitations, such as radiation exposure and potential delays in feeding and drug treatment 3, 4.
Alternative Methods for Confirming NG Tube Placement
Alternative methods for confirming NG tube placement include:
- Ultrasound-guided NG tube placement: This method has been shown to be effective in visualizing the esophagus and confirming correct placement of the NG tube 2, 5, 6.
- Bedside abdominal ultrasound (BAU): This method has been shown to have a good positive predictive value and may confirm the correct placement of NG tubes when compared with chest radiography 4.
- Point-of-care ultrasonography (POCUS): This method has been shown to enable real-time insertion of a gastric tube with high sensitivity and limited passage-related complications 5.
Key Considerations
When choosing an x-ray or alternative method for confirming NG tube placement, consider the following: