Nasogastric Tube Position Confirmation II

Introduction

This is a continuation of the Nasogastric Tube Position Confirmation page

Case 1

	This patient was referred for NGT position check prior to feeding via the NGT. Although the NGT tip is probably within the fundus of the stomach, the sidehole is likely to be within the oesophagus. This position is unacceptable. The patient had a new NGT inserted and re-imaged as shown below.
	The NGT tip and sidehole are well within the stomach.

Case 2

	This patient was referred for chest radiography for NGT position. A bedside CR technique without stationary grid was employed. The NGT is visible proximally (see above the first sternal wire suture). The radiographer considered the tip of the NGT had not been demonstrated. A lateral chest projection was employed using the DR image receptor (see below). (Kodak DirectView CR 850 system)
	The tip of the NGT was clearly demonstrated below the diaphragm and was within the stomach until proven otherwise. (Philips DR DigitalDiagnost, release I)
	The patient was re-referred for chest radiography for NGT. When the referring doctor was questioned he/she had not viewed the lateral chest image and assumed that the NGT was malpositioned. The radiographer attempted to correct the poor result with the first CR AP non-grid bedside chest technique. This time a similar technique was employed except with a stationary grid. The resultant image was of poor quality, probably due to grid cut-off. A short dimension stationary grid could have been employed to good effect. The NGT was once again demonstrated proximally only. A lateral chest technique was employed once again to try and demonstrate the NGT tip position. (Kodak DirectView CR 850 system)
	The lateral projection image demonstrated the NGT to be positioned within the patient's stomach. (Philips DR DigitalDiagnost, release I)
	This image was taken on the same day on the same patient using a CARESTREAM DRX-1 cassette without stationary grid. The DR cassette could have been useful in demonstrating the position of the NGT. Compare the image quality with the Kodak CR cassette images above.

Case 3

	This patient was referred for bedside chest radiography in the Intensive Care Unit for NGT position check. A non-grid CR technique was employed with the patient in the AP sitting position. The NGT is visible (arrowed), but the tip of the NGT is not clearly seen. (Kodak DirectView CR 850 system)
	The radiographer repeated the CXR using a stationary grid. Although the image suffers from movement unsharpness associated with a longer exposure time (note AMX mobile machine used), the NGT tip position is demonstrated (arrowed). (Kodak DirectView CR 850 system)
	The NGT was retracted 15cm (6 inches) and NGT check radiography was again requested. The radiographer (wisely) reviewed the previous NGT check image and noted the poor demonstration of the tip of the NGT. A collimated beam technique with stationary grid was employed to good effect. The NGT tube was projected over the patient's liver. Note that the patient is supine- this is the preferred position for NGT chest radiography, particularly in obese patients. LLL consolidation (air bronchogram) noted (Kodak DirectView CR 850 system)
	An abdominal CT was requested to confirm the position of the NGT. The abdominal CT demonstrated the NGT posterior to the patient's liver (arrowed)
	The patient was intubated and bedside chest radiography was requested to check the position of the ET tube. The ET tube was demonstrated in a satisfactory position (not arrowed). The NGT is again demonstrated (black arrow) and right sided pneumothorax is also demonstrated (white arrow). Note that both ends of the ET tube are demonstrated. (Kodak DirectView CR 850 system)

Case 4

This 82 year old man was found to have a non-draining NGT and was referred for chest radiography. The radiographer considered the patient to be too unwell to be subjected to PA erect chest radiography and undertook AP sitting CR technique. The NGT could be visualised proximally, but the tip position was unclear. In order to demonstrate the tip position the options included DR technique (erect or supine) or using the same CR technique with a stationery grid. THe DR option was chosen.

The erect PA DR image demonstrates the NGT tip position to be in the distal third of the oesophagus. - sternal sutures noted. - bilateral pleural effusions noted, larger on the right

....back to the applied radiography home page here