Nasogastric Tube Position Research Articles

A prospective observational study of pH testing to confirm ongoing nasogastric tube position.

To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications. Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X-rays and missed enteral nutrition and/or medications. Prospective observational study using STROBE checklist. Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X-rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability. Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X-rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication. Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one-fifth of patients required X-rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition. Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing.

Improving the Knowledge and Competency of UK Foundation Doctors in Nasogastric Tube Placement: A National Study.

Objective This study aims to improve foundation doctors' knowledge of guidelines for confirming nasogastric (NG) tube position and to enhance their confidence and competency in NGtube placement. Methods A three-part educational approach was designed, which included an educational leaflet and allowed the assessment of a participant's knowledge of guidelines pertaining to NG tube positioning before and after education. This educational leaflet and accompanying pre- and post-learning assessments were distributed among NHS Foundation Trusts in the UK between January 2022 and June 2022. All participants were foundation doctors in the UK. Those who had entered further training after the completion of their foundation training, at the time of assessment distribution, were excluded. Results A total of 173 participants completed this assessment. We found a significant increase in confidence among participants following the education (p<0.05). There was also a significant improvement in objective knowledge of guidelines on NG tube position confirmation following education (p<0.05). Conclusions Current knowledge on NG tube positioning is lacking among foundation doctors, but this can be significantly improved with simple educational leaflets. Furthermore, many participants felt that more training is needed, and this topic should be included in an essential teaching program.

Comparing outcomes of ongoing nasogastric tube position testing practice in two countries

Comparing outcomes of ongoing nasogastric tube position testing practice in two countries

139 “Never Event, Never Again” - a Closed Loop Audit on the Documentation of Nasogastric Tube Position Following X-Ray Confirmation

Abstract Aim Nasogastric feeding is common among ENT patients with dysphagia. CXRs are performed to confirm tube position before feeding. However, communication failure from poor documentation potentially leads to feeding through a misplaced tube into the lungs which is a "Never Event". This audit aims to reduce risk of patient harm by encouraging the use of nasogastric tube documentation sticker on clinical notes in Royal Victoria Hospital ENT ward. Method An initial study was conducted in June 2022 evaluating the quality of documentation of NGT position following CXR. Subsequently, several interventions were implemented including teaching doctors on utilising the documentation sticker that comes with each NGT pack, placing posters on the ward and reminding the nursing staff to check the documentation before starting feed. Further re-audit was carried out in August 2022 post-intervention. Results 58 CXRs were performed. Use of the documentation sticker rose from 42.1% to 85%. This led to verification of patient identity increasing from 39.5% to 100% and confirmation that the x-ray was most recent for the patient from 44.7% to 100%. 85% of the x-rays had time and date verified compared to 34.2% previously. Documentation of the position of NGT and instructions for feeding improved from 63.1% to 75% and 65.8% to 75% respectively. Record of the staff who confirmed tube position increased from 60.5% to 75%. Conclusions This audit demonstrated an increased use of the documentation sticker resulting in improvements in confirmation and documentation of NGT position. These positive changes reduce risks of significant patient harm thereby improving patient safety.

A clinical review of estimating the accuracy of nasogastric tube insertion depth

Inserting a nasogastric tube (NGT) is a standard procedure performed by nurses. Assuring the correct position of the tip of the NGT in the stomach is crucial for maximizing the treatment effectiveness and preventing complications due to NGT malposition. While the nose-ear-xiphoid distance is one of the simplest applied methods in estimating the depth of NGT, some studies reported that it is not accurate and is considered no longer safe and increasing the risk for NGT malposition. This literature review aimed to identify the most precise method for determining the NGT insertion depth. The article searched from some electronic sources, namely Sciencedirect and Google Scholar, using "nasogastric tube," "placement," "method," "formula," and "nursing" as the keywords and searching focused on the original research articles published in English between March 2017 – March 2022. Three pieces met the inclusion criteria. These three articles used different definitions and formulas in determining the accurate position of NGT in the stomach. Considering the rate of correct position resulting from the formulas, the xiphoid-ear-nose distance + 10 cm formula was considered the most appropriate formula to be implemented in the daily NGT tube insertion procedure. However, using this formula cannot altogether remove the risk of malposition. Therefore, confirming the position of the NGT using a gastric aspirate pH test or chest x-ray is very recommended. Keywords: Nursing intervention; nutritional status; nasogastric tube; clinical practice; nursing care

Methods Used in Confirmation of the Position of Nasogastric Feeding Tubes: Advantages and Limitations

Confirmation of the placement of the nasogastric tube is essential to ensure safe feeding without the risk of aspiration, pneumonia, and pneumothorax that may occur due to incorrect placement of the nasogastric tube. The risk of incorrect placement of the nasogastric tube may increase in the high-risk patient group, especially with some factors such as decreased consciousness, weak gag reflex, intubation, mechanical ventilation, and sedation. In addition to the problems that may occur during the initial placement of the nasogastric tube, displacement of the nasogastric tube may occur during the enteral feeding process. For this reason, tube placement should be checked regularly in order to minimize the complications of enteral nutrition. Although there are some advantages and limitations of the methods used to determine the location of the nasogastric tube, it is seen that there is no standard practice on this subject in clinics. The aim of this review is to summarize the commonly used methods for the initial placement of the nasogastric tube and the confirmation of the tube position during the feeding process and to summarize the advantages and limitations of these methods.

The accuracy of intensive care nurses' interpretation of chest radiographs to recognise misplacement of endotracheal and nasogastric tubes after a single training session and comparison with residents' interpretation

BackgroundMisplacements of endotracheal and nasogastric tubes are frequent encounters in critically ill patients. ObjectivesThe purpose of this study was to assess the effectiveness of a single standardised training session on the ability of intensive care registered nurses (RNs) to recognise the misplacement of endotracheal and nasogastric tubes on bedside chest radiographs of patients in intensive care units (ICUs). MethodsIn eight French ICUs, RNs received a 110-min standardised teaching on the position of endotracheal and nasogastric tubes on chest radiographs. Their knowledge was evaluated within the subsequent weeks. For 20 chest radiographs, each with an endotracheal and nasogastric tube, RNs had to indicate whether each tube was in the proper or incorrect position. Training success was defined as >90% for the lower bound of the 95% confidence interval (95% CI) of the mean correct response rate (CRR). Residents of the participating ICUs underwent the same evaluation (without prior specific training). ResultsIn total, 181 RNs were trained and evaluated and 110 residents were evaluated. The global mean CRR for RNs was 84.6% (95% CI: 83.3–85.9), significantly higher than for residents (81.4% [95% CI: 79.7–83.2]) (P < 0.0001). The mean CRR for RNs and residents was 95.9% (93.9–98.0) and 97.0% (94.7–99.3) for misplaced nasogastric tubes (P = 0.54), 86.8% (85.2–88.5) and 82.6% (79.4–85.7) (P = 0.07) for nasogastric tubes in the correct position, 86.6% (83.8–89.3) and 62.7% (57.9–67.5) for misplaced endotracheal tubes (P < 0.0001), and 79.1% (76.6–81.6) and 84.7% (82.1–87.2) for endotracheal tubes in the correct position (P = 0.01), respectively. ConclusionsThe ability of trained RNs to detect tube misplacement did not reach the predetermined arbitrary level, indicating training success. Their mean CRR was higher than that for residents and was considered satisfactory for detecting misplaced nasogastric tubes. This finding is encouraging but insufficient to ensure patient safety. Transferring responsibility for reading radiographs to detect the misplacement of endotracheal tubes to intensive care RNs will need a more advanced or more in-depth teaching method.

An Artificial Neural Network for Nasogastric Tube Position Decision Support.

To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision support tool for junior physicians to help determine whether feeding can be safely performed in patients (feed/do not feed). A neural network ensemble was pretrained on 1 132 142 retrospectively collected (June 2007-August 2019) frontal chest radiographs and further fine-tuned on 7081 chest radiographs labeled by three radiologists. Clinical relevance was assessed on an independent set of 335 images. Five junior emergency medicine physicians assessed chest radiographs and made feed/do not feed decisions without and with artificial intelligence (AI)-generated NGT malposition probabilities placed above chest radiographs. Decisions from the radiologists served as ground truths. Model performance was evaluated using receiver operating characteristic analysis. Agreement between junior physician and radiologist decision was determined using the Cohen κ coefficient. In the testing set, the ensemble achieved area under the receiver operating characteristic curve values of 0.82 (95% CI: 0.78, 0.86), 0.77 (95% CI: 0.71, 0.83), and 0.98 (95% CI: 0.96, 1.00) for satisfactory, malpositioned, and bronchial positions, respectively. In the clinical evaluation set, mean interreader agreement for feed/do not feed decisions among junior physicians was 0.65 ± 0.03 (SD) and 0.77 ± 0.13 without and with AI support, respectively. Mean agreement between junior physicians and radiologists was 0.53 ± 0.05 (unaided) and 0.65 ± 0.09 (AI-aided). A simple classifier for NGT malposition may help junior physicians determine the safety of feeding in patients with NGTs.Keywords: Neural Networks, Feature Detection, Supervised Learning, Machine Learning Supplemental material is available for this article. Published under a CC BY 4.0 license.

Pneumothorax after Insertion of Nasogastric Tube

A 65-year-old man was admitted to the Intensive Care Unit (ICU) for invasive mechanical ventilation after a significant intraventricular bleed. When his nasogastric tube (NGT) was accidentally removed, a new NGT was inserted blind. The pH of the thick green aspirate was under five and so enteral feeding was restarted. However, the patient subsequently deteriorated with rapidly worsening respiratory failure and invasive ventilation was required. An X-ray revealed misplacement of the NGT into the right lung with consolidation, pleural effusion, and pneumothorax. This highlights that indirect techniques to check NGT position (e.g., air insufflation and abdominal auscultation, aspirate appearance and pH) are unreliable. Even X-ray only detects misplacement after the event and mistakes have occurred because previous X-rays from the same patient have erroneously been reviewed. Only real-time visualization can prevent bronchopulmonary misplacement and the associated risks of pneumothorax and microbial contamination. The authors' current practice is therefore to use laryngoscopy, endoscopy, or fluoroscopy for insertion of all NGT in patients in ICU with impaired airway protective reflexes.

Fibre-optic, electronic pH test device compared with current NHS guidance to confirm nasogastric tube placement

The clinical objectives of this prospective, random, convenience series were:1. Compare a novel fibre-optic pH test device (NGPOD) to gastric aspirate and pH testing for nasogastric tube (NGT) confirmation.2. Determine...

Application of point-of-care ultrasound in patients receiving enteral nutrition.

Enteral nutrition (EN) is the first-choice nutritional support, as it is more in line with normal physiological processes. During EN, the major goals to achieve include accurate confirmation of the feeding tube position, monitoring the gastric residual volume, assessing gastrointestinal motility, and monitoring the nutritional status of patients. With rapid development in technology, point-of-care ultrasound (POCUS) has become a more convenient and effective technical tool for monitoring critically ill patients receiving EN. In this review, we have summarized and discussed the value of POCUS in the implementation, monitoring, and evaluation of EN therapy to provide a reference for nutritional support of critically ill patients in critical care settings. This is a narrative review. A literature search for Scopus-indexed articles was performed randomly using PubMed and MEDLINE databases as the primary sources. No specific term was used for the search. POCUS can be used for positioning of nasogastric and nasointestinal tubes, evaluation of gastric residuals and gastrointestinal motility as well as monitoring of nutritional status. POCUS is a real-time, highly repeatable, radiation-free, and non-invasive visual inspection technique, with high application value in assessing the nutritional status of patients receiving EN and guiding the development of further nutritional treatment plans. It is an important diagnostic and monitoring tool that can be used by the clinicians in the ICU.

Ultrasonographic Confirmation of Nasogastric Tube Placement in the COVID-19 Era.

Background: Nasogastric tube (NGT) placement is a daily routine in the Intensive Care Unit (ICU), and misplacement of the NGT can cause serious complications. In COVID-19 ARDS patients, proning has emerged the need for frequent NGT re-evaluations. The gold standard technique, chest X-ray, is not always feasible. In the present study we report our experience with the use of ultrasonographic confirmation of NGT position. Methods: A prospective study in 276 COVID-19 ARDS patients admitted after intubation in the ICU. Ultrasonographic evaluation was performed using longitudinal or sagittal epigastric views. Examinations were performed during the initial NGT placement and every time the patients returned to the supine position after they had been proned or whenever critical care physicians or nurses considered that reconfirmation was necessary. Results: Ultrasonographic confirmation of correct NGT placement was feasible in 246/276 (89.13%) patients upon ICU admission. In 189/246 (76.8%) the tube could be visualized in the stomach (two parallel lines), in 172/246 (69.9%) the ultrasonographic whoosh test (“flash” due to air instillation through the tube, seen with ultrasonography) was evident, while in 164/246 (66.7%) both tests confirmed correct NGT placement. During ICU stay 590 ultrasonographic NGT evaluations were performed, and in 462 (78.14%) cases correct NGT placement were confirmed. In 392 cases, a chest X-ray was also ordered. The sensitivity of ultrasonographic NGT confirmation in these cases was 98.9%, specificity 57.9%, PPV 96.2%, and NPV 3.8%. The time for the full evaluation was 3.8 ± 3.4 min. Conclusion: Ultrasonographic confirmation of correct NGT placement is feasible in the initial placement, but also whenever needed thereafter, especially in the COVID-19 era, when changes in posture have become a daily practice in ARDS patients.

Preventive Care for Aspiration Pneumonia in Patients With an Indwelling Nasogastric Tube

More than 190,000 patients have been fitted with an indwelling nasogastric tube in Taiwan. Nasogastric tube feeding is a strategy for temporary or long-term feeding and for preventing aspiration pneumonia in patients with dysphagia. However, aspiration pneumonia is a common complication in patients fitted with a nasogastric tube. Displacement of the nasogastric tube, inappropriate length of the placed nasogastric tube resulting gastroesophageal reflux, inappropriate feeding posture and speed, and excessive gastric residual volume resulting in vomiting are important risk factors associated with aspiration pneumonia. In this article, the literature and clinical practice experiences were reviewed to identify methods used to confirm the length and positioning of nasogastric tubes. We further explored strategies for preventing oral-care and tube-feeding-induced aspiration pneumonia during the period of indwelling nasogastric tube. These strategies included adjusting the patient's positions for receiving tube feedings, feeding techniques, methods and frequency of gastric residual volume measurement, and conditions for stopping nasogastric feeding. This exploration was intended to provide nursing staff with relevant knowledge and skills for preventing aspiration pneumonia in patients with indwelling nasogastric tube to improve patient safety.

Ongoing pH testing to confirm nasogastric tube position before feeding to reduce the risk of adverse outcomes in adult and paediatric patients: A systematic literature review.

There is no agreed gold standard method to confirm nasogastric tube position before every use. However, many global guidelines recommend testing the pH of gastric aspirates obtained from an NGT before each use. This study aims to determine whether ongoing pH testing has been shown to reduce adverse events. Secondary aims are to determine how frequently aspirates can be obtained, and how often pH correctly confirms ongoing NGT tip position. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and protocol was published on PROSPERO. Keywords were used to search PubMed, Embase, CENTRAL, CINAHL and MEDLINE. Article assessment for inclusion was completed by two independent authors and risk of bias was assessed using ROBINS-I. The systematic search and review methodology was followed due to wide variety and high risk of bias in the included studies. One full study and five abstracts met inclusion criteria for the primary aim. The full article contained one instance where pH testing and external NGT length together identified a misplaced NGT. The abstracts identified missed or delayed feeds and medications, and frequent unnecessary X-rays, as negative outcomes of ongoing pH testing. Ten full studies and one conference abstract addressed the secondary aims, but the studies varied widely which prevented meta-analysis and made it difficult to draw conclusions. This review confirmed that ongoing pH testing is based on expert opinion due to limited evidence. More primary research is required to determine the clinical impact of ongoing pH testing to confirm NGT position.

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

X-ray checks of NG tube position: a case for guided tube placement.

Checking nasogastric (NG) tube position by X-ray is too late to prevent 1.5% of blind tube placements entering the lung and results in delays to feeding and drugs. We audit the safety of the tube position and delay incurred by X-ray. From Radiology reports, we determined whether tube position was safe for feeding, factors associated with an X-ray request and the time delay from X-ray request to that report. For tubes misplaced into the lung, the distance from the carina to tube tip was measured and compared with that from published records of guided tube placement. From 1 July 2019 to 30 June 2020, 1934 X-rays were done to check NG tube position in 891 patients. Gastric placement was confirmed in 85% but, because of tube proximity to the oesophagus, only 73% were deemed safe to feed. The 2.2% of tubes reported to be in the lung were a median of 18 cm beyond the carina compared to 12 cm and 0 cm for electromagnetic and direct vision methods of guided placement. X-ray checks delayed feed and drug treatment by >2 h in 51% of placements and 33% of patients required >3 X-rays during their enteral episode. X-ray checks are common and detect a high percentage of unsafe tube placements, leading to repeated X-ray and delayed delivery of drugs and nutrition. Interpretation can be difficult even when following standard national criteria and post-placement X-ray cannot prevent deep lung placement. Guided or combined methods of confirming tube placement should be investigated. Reports included 27.5% of placements as unsafe, 2.2% in the lung at a median depth of 18 cm beyond the carina and too late to prevent 7 pneumothoraces. X-rays were repeated >3 times in 33% of patients over their enteral course and we are associated with clinically significant delays to drug treatment (and nutrition) in 51%; combined methods of tube confirmation or guided placement may be safer and more efficient.

A Low-Cost, Point-of-Care Test for Confirmation of Nasogastric Tube Placement via Magnetic Field Tracking.

In this work, we aim to achieve low-cost real-time tracking for nasogastric tube (NGT) insertion by using a tracking method based on two magnetic sensors. Currently, some electromagnetic (EM) tracking systems used to detect the misinsertion of the NGT are commercially available. While the EM tracking systems can be advantageous over the other conventional methods to confirm the NGT position, their high costs are a factor hindering such systems from wider acceptance in the clinical community. In our approach, a pair of magnetic sensors are used to estimate the location of a permanent magnet embedded at the tip of the NGT. As the cost of the magnet and magnetic sensors is low, the total cost of the system can be less than one-tenth of that of the EM tracking systems. The experimental results exhibited that tracking can be achieved with a root mean square error (RMSE) of 2–5 mm and indicated a great potential for use as a point-of-care test for NGT insertion, to avoid misplacement into the lung and ensure correct placement in the stomach.

Immediate chest radiograph interpretation by radiographers improves patient safety related to nasogastric feeding tube placement in children

BackgroundDespite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results.ObjectiveThe objectives were to determine whether training in a new pathway introduced to avoid these “never events” was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children.Materials and methodsFollowing radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0–16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes.ResultsWe reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95–0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes.ConclusionNasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.

Endoscopic management of enteral tubes in adult patients - Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

ESGE recommends the "pull" technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.Strong recommendation, low quality evidence.ESGE recommends the direct percutaneous introducer ("push") technique for PEG placement in cases where the "pull" method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.Strong recommendation, low quality evidence.ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.Strong recommendation, moderate quality evidence.ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).Strong recommendation, low quality evidence.ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed "blindly" at the patient's bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.Strong recommendation, low quality evidence.ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).Strong recommendation, low quality evidence.ESGE recommends that EN may be started within 3 - 4 hours after uncomplicated placement of a PEG or PEG-J.Strong recommendation, high quality evidence.ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 - 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.Strong recommendation, low quality evidence.

Validation of sonographic assistance for placement of a nasogastric tube in pediatric patients.

Enteral access via nasogastric tube (NGT) placement can be essential in the provision of care in pediatric patients. Methods exist to confirm correct placement with success rates between 80% and 85%. Radiographic confirmation remains the "gold-standard," however; it exposes patients to ionizing radiation and fails to provide "real-time" information. In this study, we determined the feasibility of using sonography to assist in the placement of NGT insertions in pediatric patients that have difficulty cooperating. Thirty patients requiring NGT placement were stratified into three age groups. Upon NGT insertion, transverse and longitudinal ultrasound images were acquired to visualize tube progression through the esophagus. Subsequently, a focused ultrasonographic exam of the gastric antrum and body were performed. If amenable, an air bolus (1 mL/kg) was injected in the stomach if the NGT was not directly visualized. Following intubation, standard guidelines for NGT position confirmation were performed. The NGT was visualized in all esophageal views and 52% of gastric views. Subgroup analysis showed that successful visualization of tube placement in the stomach ranged from 40% (7-18 years) to 70% (3-6 years). Eighty percentage of air boluses injected were visualized. The use of ultrasonography may assist NGT placement in pediatric patients and reduce the incidence of suboptimal placement during insertion. We demonstrated successful NGT visualization through the esophagus regardless of age. NGT visualization in the stomach was challenging; however, injection of an air bolus may improve visualization. Further studies are required to improve the success rate of obtaining gastric views of the NGT.