Journal of Ultrasound

, Volume 20, Issue 1, pp 53–58 | Cite as

4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients

  • Marianna Zatelli
  • Norberto Vezzali
Original Article



Nasogastric feeding tube is routinely positioned in intensive care units. The complications of misplacement are rare but very dangerous for the patients. The aim of this study is to estimate the diagnostic accuracy of this new technique, 4-point ultrasonography to confirm nasogastric tube placement in intensive care.


One hundred fourteen critical ill patients monitored in ICU were included. The intensivist provided in real time to perform the exam in four steps: sonography from either the right or left side of the patient’s neck to visualize the esophagus, sonography of epigastrium to confirm the passage through the esophagogastric junction and the positioning in antrum, sonography of the fundus. Finally, gastric placement of the nasogastric feeding tube was confirmed with thorax radiograph.


One hundred fourteen of the gastric tubes were visualized by sonography in the digestive tract and all were confirmed by radiography (sensitivity 100%). The entire sonographic procedure, including the longitudinal and transversal scan of the esophagus, the esophagogastric junction, the antrum and the fundus, took 10 min.


Our pilot study demonstrated that not weighted-tip gastric tube routinely used in Intensive Care is visible with the sonography. The pilot study confirmed the high sensitivity of the sonography in the verify correct positioning of gastric tube in the adult ICU patients. The ultrasound examination seems to be easy and rapid even when performed by a intensivist whit a sonographic training of only 40 h. The sonographic exam at the bedside was performed in a shorter time than the acquisition and reporting of the X-ray.


Enteral nutrition Nasogastric tube Sonography 



Il sondino nasogastrico viene posizionato routinariamente in Terapia Intensiva. Le complicanze del malposizionamento sono rare ma estremamente pericolose per il paziente. Lo scopo del nostro studio è stimare l’accuratezza diagnostica di una nuova tecnica ecografica a 4 punti per confermare il posizionamento del sondino nasogastrico in Terapia Intensiva.


Nello studio sono stati inclusi 114 pazienti ricoverati in Terapia Intensiva. L’intensivista ha provveduto in tempo reale all’esecuzione dell’esame ecografico in 4 punti: ecografia della parte destra e sinistra del collo del paziente per visualizzare l’esofago, ecografia dell’epigastrio per confermare il passaggio attraverso la giunzione esofagogastrica ed il posizionamento nell’antro, infine ecografia del fondo gastrico. Il posizionamento veniva confermato attraverso l’esecuzione della lastra del torace.


L’ecografia ha visualizzato 114 sondini nasogastrici nel tratto digestivo e tutti sono stati confermati dalla lastra del torace (sensitività del 100%). L’intera procedura ecografica, inclusa la scansione longitudinale e trasversale dell’esofago, della giunzione esofagogastrica, dell’antro e del fondo ha necessitato di 10 minuti.


Il nostro studio pilota ha dimostrato che il sondino nasogastrico non pesato in punta utilizzato routinariamente in Terapia Intensiva è visibile con l’ecografia. Lo studio pilota ha confermato l’alta sensitività dell’ecografia nella verifica del corretto posizionamento del sondino nei pazienti adulti di Terapia Intensiva. L’esame ecografico si è dimostrato facile e rapido anche se eseguito da un intensivista con un training ecografico di sole 40 ore. L’intero esame ecografico al letto del paziente è stato eseguito in un tempo minore rispetto all’acquisizione e alla refertazione della lastra del torace.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2016

Authors and Affiliations

  1. 1.Department of Intensive CareRegional Hospital of BolzanoBolzanoItaly
  2. 2.Department of RadiologyRegional Hospital of BolzanoBolzanoItaly

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