How accurate are X-rays to check NG tube positioning?

The position of a nasogastric tube is vitally important for patients' safety and wellbeing. X-rays are sometimes used to determine whether nasogastric tubes are correctly positioned, but how effective are they? To find out, we undertook an audit of data from the radiology information system, collating all reports that included the word "nasogastric" from 1 January 2010 until 15 May 2011. For each report the description of tube position was put in one of six categories from "fully compliant with NPSA [National Patient Safety Agency] requirements" to "image missing". In a second, smaller dataset (cases in which some anatomy was described), we investigated the position of the tube tip as classified using descriptions from radiology reports. None of the reports contained all of the information required to comply with NSPA's (2011) guidelines, but most nasogastric tubes (70%) were in the stomach. Twenty-one per cent were reported as being in the oesophagus; advice varied from advancing it further (if uncomplicated) to removing it (if coiled or looped). Four per cent of tubes were seen in the airways (lung or bronchus) with advice for immediate removal.