Watkin D, Farrell C, McGee M, Welters I
Royal Liverpool University Hospital, Liverpool University Hospitals Foundation Trust, Mount Vernon St, Liverpool, L78YE, England.
Radiography (Lond). 2025 May;31(3):102941. doi: 10.1016/j.radi.2025.102941. Epub 2025 Apr 7.
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.
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.
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.
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.
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.
通过放置位置不正确的鼻胃管（NGT）进行喂食会引发严重并发症。我们对重症监护人群中经X光片诊断的鼻胃管插入操作的管理及并发症情况进行审核。
对为确定鼻胃管位置而进行的X光片以及随后采取的临床措施进行回顾性分析。从放射学报告中提取鼻胃管位置及开始肠内喂养的安全性信息。
在2021年7月至2022年12月期间，共进行了512次X光检查，其中508次足以确定鼻胃管位置。10%的X光片显示鼻胃管位置不正确。所有无意中插入气道（2.2%，11/512）或盘绕在食管近端（1.0%，5/512）的鼻胃管均被拔除。35根鼻胃管成像显示位置欠佳，位于食管远端或胃近端；然而，只有51%（18/35）被重症监护临床医生推进。在46%（16/35）的病例中，放射学报告未明确评论使用的安全性或建议推进鼻胃管。
X光片能持续检测到鼻胃管误置。然而，并非所有不安全的放置情况都按照现有指南由临床团队进行了优化。放射学报告在描述鼻胃管用于喂养或给药的安全性时并不总是明确的。未来的质量改进项目应旨在提高对现有鼻胃管指南的依从性，并规范放射学报告。包括由放射技师主导的鼻胃管位置检查流程在内的新举措可能会提高重症监护中鼻胃管插入的效率和安全性。
投照式X光检查仍然是检测重症患者鼻胃管误置的一种敏感筛查方法。遵守既定的鼻胃管位置确认诊断标准和标准化报告对于避免并发症至关重要。
