Specifics in Reporting

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Specifics in Reporting
Portable Chest and Abdominal X-Rays for Gastric and Gastro-Enteric Tube Positioning
J AMES BOV A, D.O.
While there are specific bedside methods to determine proper placement of “nasogastric” (NGT), “orogastric”
(OGT) or “feeding” tubes, portable chest and/or abdominal X-rays are commonly performed to confirm
position.
There are three common uses of gastroenteric tubes: 1) bowel decompression; 2) administration of
medications; and 3) enteral feeding.
Many types of tubes are available to place for these uses, but the most commonly used are Levin
(multipurpose), Salem Sump (multipurpose) and Dobbhoff (enteral feeding).
Unfortunately we as radiologists are rarely informed of the specific type of tube placed and the term
“nasogastric tube (NGT)” is most commonly used for any type of tube inserted.
We are also usually not informed as to the specific purpose of the tube place nor if there is surgically altered
anatomy of the upper gastrointestinal tract. These factors are important to know because they determine
what is the acceptable position.
For the most common indication of gastroenteric decompression the NGT tip should be well seated in the
fundus or body of the stomach. A more distal position (antrum) is also acceptable for this indication. However,
gastric decompression may not occur if the tube is in the duodenum.
The positioning of standard NGT described above is also acceptable for administration of medications and
nutritional support if there are no issues with gastric emptying.
Dobbhoff (or Dobhoff – DHT) enteral feeding tubes are commonly identified in the clinical history as a
“nasogastric tube (NGT)” but should more properly be termed as “Dobbhoff feeding tube (DHT)”. Fortunately
it has a distinctive appearance on X-rays and should be appropriately reported as such. Its optimal position for
enteric feeding should be just beyond the ligament of Treitz. However, the fourth portion of the duodenum
can work if there is no duodenal peristalsis issue.
Specifics in the report should include the type of tube (if known or identifiable) and its most visible end point
location. The report should also include any kinking or coiling on itself seen along its course. Of course, any
unusual or abnormal anatomic location should be documented.
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COMPLICATIONS REQUIRING CRITICAL FINDING REPORTING
1. If the study is performed to evaluate gastroenteric tube placement and no tube is seen. It may be
malpositioned outside the field of view, such as the pharynx.
2. Tube located in the pharynx, trachea or bronchus.
3. The course of the tube is unusual and may be outside the lumen of the esophagus or stomach.
4. Tube tip is in the esophagus (as it won’t work for decompression and should not be used for
administering medications or nutritional support).
REFERENCES
Itkin M, DeLegge MH, Fang JC, McClave SA, Kundu S, Janne d'Othee B, et. al. Multidisciplinary practical guidelines for
gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and
American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological
Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol.
2011; 22:1089-1106. [online]
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