Improving Outcomes Through Radiologic Verification: A Quality Improvement Approach to Nasogastric Tube Placement

Abstract

In critical care, nasogastric (NG) tube placement is a routine procedure and is necessary for enteral feeding, medication administration, and gastric decompression. Regardless, misplacing NG tubes continues to be a common issue and can result in severe complications, such as aspiration, pneumothorax, and gastrointestinal perforation. Although chest radiographs are the gold standard imaging test to verify the placement of an NG tube, misinterpretation is still a problem, particularly for non-radiologists. Our case report is a quality improvement initiative that explores the role of radiologic verification in improving outcomes and preventing complications associated with misplaced NG tubes. We present the case of a patient whose NG tube was misplaced in his lung. We also examine the limitations of radiographic imaging as the standard method for confirming NG tube placement. We examine the potential for improving patient safety by providing radiographic training, standardizing interpretation protocols, and integrating advanced technologies such as artificial intelligence (AI)-assisted detection. Our case report explores the importance of continuous quality improvement efforts in optimizing NG tube placement accuracy and reducing associated risks, ultimately enhancing patient care and safety.

Keywords: artificial intelligence; chest radiograph; critical care; deep learning; electromagnetic guidance; nasogastric tube.

Figure 1. Chest radiograph obtained prior to nasogastric tube insertion.

Figure 2. Chest X-ray showing a nasogastric (NG) tube mistakenly placed in the right lung (red arrow).