What can I do to aid the accuracy of X-rays in checking NG tube positioning?

Key points

1. The position of a nasogastric tube is vitally important as accidental administration of feed into the lungs can lead to fatal complications
2. The gold standard method of detecting the position of nasogastric tubes is by X-ray, but this is not used routinely due to the risk of radiation exposure, cost and delay in feeding
3. X-ray is indicated when the tube’s position cannot be confirmed by aspiration
4. A recent National Patient Safety Agency (2011) alert drew attention to the risk of misinterpretation of X-rays used to confirm the position of a nasogastric tube
5. All staff who may request or interpret X-ray images of nasogastric tube positions must be trained and assessed as competent

Let’s discuss

• What are the risks associated with using a misplaced nasogastric tube?
• What is the first line method, recommended in this article, for checking the position of a nasogastric tube?
• When should x-rays be used to confirm the position of a nasogastric tube? What risks are associated with using x-ray?
• The audit reported in this article found that 21% of nasogastric tubes were in the oesophagus.
• What pH test result would you expect from aspirate obtained from the oesophagus? What method can you use to estimate the length of tube that should be inserted in order to reach the stomach?
• Who should interpret X-ray results and what training is recommended?

You can email questions to Eileen.shepherd@emap.com or tweet @eileenshepherd

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