Work

Complications of nasogastric tube insertion in critical care: A retrospective analysis of radiographs performed for determination of tube position

Year: 2025

Type: article

Abstract: INTRODUCTION: Feeding through incorrectly placed nasogastric tubes (NGTs) is associated with severe complications. We audit the management and complications of NGT insertions diagnosed on radiographs in a critical care population. METHODS: Radiographs performed to ascertain NGT position, and subsequent clinical actions taken were retrospectively analysed. Nasogastric tube position and safety to initiate enteral feeding were extracted from radiology reports. RESULTS: From July 2021-December 2022, 512 radiographs were performed, of which 508 were sufficient to determine NGT position. Ten percent of radiographs demonstrated incorrect NGT position. All NGTs inadvertently placed in the airway (2.2 %, 11/512) or coiled in the proximal oesophagus (1.0 %, 5/512) were removed. Thirty-five NGTs were imaged in a suboptimal position, positioned in either the distal oesophagus or proximal stomach; however, only 51 % (18/35) were advanced by intensive care clinicians. In 46 % (16/35), radiology reports did not explicitly comment on the safety of use or recommend advancement of the NGT. CONCLUSION: Radiographs consistently detected NGT misplacement. However, not all unsafe placements were optimised by clinical teams in line with existing guidance. Radiology reports were not always explicit in describing the safety of the NGT for feeding or drug administration. Future quality improvement projects should aim to improve compliance with existing NGT guidance, and standardise radiology reports. New initiatives, including the Radiographer Led Nasogastric Tube Position Check Pathway may improve the efficiency and safety of nasogastric tube insertion in critical care. IMPLICATIONS FOR PRACTICE: Projectional radiography remains a sensitive screening method to detect NGT misplacement in the critically unwell. Compliance with established diagnostic criteria for confirmation of NGT position and standardised reporting are essential to avoid complications.

Source: Radiography

DOI: 10.1016/j.radi.2025.102941

Authors: D. Watkin, C. Farrell, M. McGee, I. Welters

Institutions: Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust

Language: English

Topic: Clinical Nutrition and Gastroenterology

Subfield: Nutrition and Dietetics

Field: Nursing

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,990