Beyond the carina
  • If the tube does not pass below the
  • diaphragm feeding should not occur
  •  
  • It may be possible to advance the tube
  • if it is felt to be in the oesophagus, if the
  • NGT still has the guidewire in situ
  •  
  • In this situation aspirate may then be
  • obtained meaning a further X-ray would
  • be unnecessary
  •  
  • Obviously sometimes tubes do not
  • pass below the diaphragm due to being
  • coiled higher up as in this example
  •  
  • In this situation the tube should be
  • removed and resited
  •  
  • If there is a suspicion of any abnormal
  • anatomy causing this (e.g. pharyngeal
  • pouch) then fluoroscopic intubation
  • should be considered