Nasogastric tube location: a diagnostic dilemma

Excerpt

A 79-yr-old woman was admitted to hospital with presumed respiratory sepsis. Her past medical history included hypertension, coronary artery disease, and a hiatus hernia. She was initially managed with non-invasive ventilation, antibiotics, and vasopressors. To allow enteral feeding, a wide-bore (14 Fr) nasogastric tube (NGT) was inserted, and its position was provisionally confirmed using auscultation of injected air, although nothing could be aspirated from it. Chest radiography (CXR) was performed for definitive confirmation of the NGT position before initiating feeding, which revealed that the NGT tip appeared to be in the right lung base (Figure). Assuming misplacement, the NGT was removed, and the procedure was abandoned. Later the same day, the patient’s respiratory status deteriorated, and she was intubated and ventilated.

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