Retrospective Evaluation of a Standardized Image-Guided Nasogastric Tube Placement Protocol for Preventing Airway...

To evaluate the effectiveness of a standardized placement protocol in preventing inappropriate airway placement of nasogastric tubes (NGTs).

Retrospective study.

University teaching hospital.

Five hundred eighty-two client-owned dogs and cats undergoing NGT placement between September 2021 and March 2023.

Medical records and digital radiographic records of all dogs and cats that were charged for NGT from September 1, 2021, to March 1, 2023, were reviewed. Data collected included patient species, breed, sedation protocol, proper or improper radiographic placement on thoracic inlet (TI) and last rib (LR) images, whether a stylet was used, and the number of attempts for successful placement in the stomach.

A total of 582 NGT placement events were included, with 415 in dogs and 167 in cats. Airway positioning of the NGT was identified in the TI image in 57 events. Fifty-two of these were corrected immediately, and five were improperly advanced into the small airways due to operator misinterpretation of the TI image. Four small airway NGT misplacements were corrected and replaced prior to NGT use, with a total of 581 successful placement events. Median number of attempts for successful placement was 1 (range 1-9). Sedation was utilized in 515 of 582 placements and general anesthesia in 37 of 582. A stylet was used in 421 of 582 placement events. There was no association found between the use of sedation, anesthesia, or a stylet and airway positioning in the TI image.

The described protocol identified initial NGT placement into the trachea in 9.8% of cases. Prevention of inappropriate small airway placement requires both adherence to protocol and appropriate image interpretation.