Chest X-ray - Tubes
NG Tubes - Complications

Key points

  • Incorrect positioning of a nasogastric tube is common
  • Passing food or medication via a NG tube into the airways carries a high risk of mortality

When placing a nasogastric tube (NG tube) it is important to appreciate that its tip may not be positioned correctly in the stomach and may be aspirated rather than swallowed.

Passing food or medication via a NG tube into the airways carries a high risk of mortality. For this reason patients are not given food or medication via a nasogastric tube until its position has been determined, preferably by aspiration of gastric fluid through the tube.

NG tube misplacement - Looped

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NG tube misplacement - Looped

  • The tube passes below the level of the carina and does not follow the course of the right or left bronchi
  • The tube is, therefore, in the oesophagus and has not been inhaled
  • The tube is looped back on itself so its tip is located in the upper oesophagus
  • Feeding via a tube in this position would risk aspiration of the feed into the lungs
  • The tube must be repositioned

Tube misplacement in right main bronchus

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Tube misplacement in right main bronchus

  • The tube follows the course of the right main bronchus
  • Its tip is projected over the lower zone of the right lung
  • The NG tube has been inhaled rather than swallowed
  • The tube must be removed and repositioned

Tube misplacement in proximal stomach

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Tube misplacement in proximal stomach

  • This tube has reached the stomach but it is not in a safe position for feeding
  • If left in this position there is a risk of it being displaced proximally when the patient changes posture
  • For safe positioning it is recommended that a NG tube tip is located at least 10 cm distal to the gastro-oesophageal junction (green target area)

Tube misplacement in duodenum

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Tube misplacement in duodenum

  • The gastroduodenal junction is located just to the right side of the midline (spine indicates midline)
  • To ensure the tube is not in the duodenum, its tip is ideally placed more proximally in the stomach to the left of the midline
  • For feeding into the stomach this tube should be withdrawn and its position confirmed either by a further attempt of aspiration of gastric fluid or by repeating the X-ray

Page author: Salisbury NHS Foundation Trust UK (Read bio)

Last reviewed: February 2025