QuestionSBA
QuestionChoice
The NG tube is sited in the right lower lobe of the lung. Waiting for a day would risk serious consequences without any benefit, as the NG tube will not re-site itself. The appropriate choice in this scenario is to remove the NG tube immediately.
10035831
e
Repeat the CXR the next day before starting the feed
QuestionChoice
An NG tube should go down the midline, along the route of the oesophagus and bisect the carina. It should then cross the diaphragm and have the tip visible below the left hemidiaphragm (i.e. in the stomach). In this X-ray the NG tube does not bisect the carina and the tip is seen in the right lower lobe of the lung. It needs to be removed immediately before causing any further lung damage and before anything is given via the NG.
10035827
a
Remove the NG tube
QuestionChoice
This is typically used as a technique to try and obtain NG tube aspirate. In this case, the CXR shows the NG tube is already incorrectly sited and trying to obtain aspirate would therefore be limited in use.
10035830
d
Turn the patient on their left side to try and obtain aspirate
QuestionChoice
This would be incredibly dangerous as the NG tube is seen in the right lower lobe of the lung. Commencing feeding in this scenario could be fatal.
10035828
b
Commence feeding
QuestionChoice
This is typically used as a technique to try and obtain NG tube aspirate. In this case, the CXR shows the NG tube is incorrectly sited and trying to obtain aspirate would therefore be limited in use.
10035829
c
Inject 10ml of air into the tube
Concept
Chapter
2693
6153
NG tube placement
Topic
177
Anaesthetics and Intensive Care Medicine
19569
An incorrectly positioned nasogastric tube can lead to serious complications, including aspiration pneumonia, necessitating immediate removal.
Picture
2797
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A 57-year-old male patient has severe malnutrition. He has a history of alcoholism and drinks 1 litre of vodka a day, with minimal solid food intake. He is treated for alcohol withdrawal with a weaning regimen of oxazepam and vitamin B supplementation. He is reviewed by dieticians who suggest controlled NG feed regimens and daily blood monitoring whilst the patient is at risk of re-feeding syndrome. The patient had an NG tube placed but the staff were unable to obtain aspirate at the time of insertion. A CXR is taken to confirm its position. The X-ray is seen below:

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Based on the CXR, what is the most appropriate course of action?
a