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

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.