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Modified Mondays: Horseshoes and Hand Grenades

NG tubes are comfortable and convenient…said no patient ever. The fact is, most patients do not want NG tubes, and if they are placed, they prefer to have them taken out as soon as possible. This is understandable since there are complications that can arise from NG tube placement. These include pneumonia, sores, infections, nausea, constipation, and diarrhea.

In today’s Modified Monday, we have a patient who had taken out their NG tube twice before. Prior to this MBSS, one of our Cleveland areas SLPs, Malinda, noticed that the tubing seemed a bit longer than normal outside of the patient’s nose. When she saw the esophageal follow through, she did a double take and noticed the metal end of the NG tube was in the distal esophagus, not in the stomach where it would be if properly placed.

Even when the NG tube is close to the GE juncture, if it is not through (at least 10 cm), then improper placement can cause respiratory issues and regurgitation of tube feedings. As the old saying goes, close only counts in horseshoes and hand grenades.

Fortunately, the patient did well on his MBSS and the NG tube was removed immediately after.

Nasogastric tube positioning | Radiology Reference Article |

Checking nasogastric (NG) tube position - Oxford Medical Education

The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia - PubMed (

Reducing nasogastric tube misplacement through evidence-based practice (

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