DDX of nasogastric tube malfunction

Approach to the DDX of nasogastric tube malfunction:

  • The correct position for a nasogastric tube tip should be beneath the gastroesophageal junction and well into the stomach
  • Nasogastric tube tip that crosses to the right of the spine and then heads superiorly before turning back to the left of the spine is most likely still in the stomach
  • Nasogastric tube tip that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine is most likely in the duodenum
  • Inability to advance the nasogastric tube into or through the nose in a newborn or infant is usually due to priform aperture stenosis or choanal atresia
  • Inability to advance the nasogastric tube into the stomach in a newborn is usually due to esophageal atresia
  • Placement of the nasogastric tube tip into the airway or lung or pleural space can result in pneumothorax or aspiration with feedings
  • Pnemopericardium, pneumomediastium, or pneumothorax after nasogastric tube placement should raise suspicion for perforation of the esophagus
  • A nasogastric tube that is too straight after placement and that does not gently curve into the stomach should be suspected of not being in the stomach
  • A nasogastric tube tip that projects over the pelvis should be suspected of not being in the stomach
  • Pneumoperitoneum after nasogastric tube placement is due to perforation of the stomach
  • Kinking of the nasogastric tube leads to its obstruction
  • Trans-pyloric placement of the nasogastric tube tip can result in a misdiagnosis of bilious emesis