UMEM Educational Pearls


4 year-old female with the post-procedural CXR shown below. What's the diagnosis? (Hint: use the zoom...this one is tricky)



Answer: Nasogastric tube in the left mainstem bronchus. Patient was asymptomatic but ironically bubbling was heard when air was injected into the NG tube.


Nasogastric tube (NGT) pearls

The risk of NGT misplacement is 4% in adults, but is 21-43% in children.

Risk factors for misplacement are:

  • Younger age
  • Altered mental status
  • Abdominal distention
  • Dysphagia

The ability to aspirate gastric contents, pH testing of the aspirated fluid, and the auscultation of “bubbling” over the epigastrium have all been suggested as reliable methods to confirm proper placement; unfortunately, they are often unreliable.

Visualization of the NGT by X-ray is the only way to be 100% certain of placement.

The risks of misplacement include pneumonia and pneumothorax.

Farrington et al. Nasogastric tube placement verification in pediatric and neonatal patients. Pediatric Nursing. Jan-Feb 2009. Vol 35. Issue 1.


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