NG Tubes pathway

The pathway provides a clear, structured process by which radiographers confirm NG tube position on a chest X‑ray before feeding or medication is commenced.

At its core is a four‑question check, applied consistently to every NG tube chest X‑ray, which helps determine whether the tube is in a safe position or whether immediate action is required.

The pathway is designed to:

• reduce variation in practice

• support timely decision‑making

• prevent misinterpretation of images

• ensure appropriate escalation and documentation

It does not replace clinical judgement or local governance processes. Instead, it provides a reliable safety framework that can be embedded within existing systems.

NG tube misplacement is a recognised never event risk. Delays in interpretation, inconsistent checks, or unclear responsibility can all contribute to harm.

The pathway supports patient safety by:

• ensuring every NG tube X‑ray has a recorded clinical evaluation before use

• reducing reliance on informal or undocumented checks

• supporting early identification and removal of misplaced tubes

• clarifying accountability across the multidisciplinary team

Services that have adopted the pathway report quicker decision-making, improved confidence, clearer escalation routes and greater consistency in practice.

The pathway focuses on what must be in place before an NG tube is used:

1. A standardised NG tube chest X‑ray request

   NG tube position checks are clearly identified, ensuring the image is acquired and prioritised appropriately.

2. A structured contemporaneous clinical evaluation of tube position

   The image is assessed against four agreed criteria by the radiographer at the time the x-ray is acquired, that quickly determines whether the tube is safely positioned.

3. Clear actions based on the outcome

   a. If all criteria are met, the evaluation is recorded and the ward team can proceed.

   b. If the tube is misplaced or unclear, immediate action and escalation are triggered.

4. Documented communication and governance

   Actions taken and communications with ward staff are recorded, supporting audit, learning and assurance.

Radiographer empowerment and workforce training is a highly effective strategy to reduce nasogastric tube-related never events: radiographers can highlight misplaced nasogastric tubes and initiate actions to rectify this at the time they acquire the nasogastric tube X-ray. A key principle of the pathway is that staff must be appropriately trained, supported and authorised to undertake this role.

The programme includes:

• a national education package with interactive cases and assessment, hosted by RAIQC

• clear expectations around competence, supervision and audit

• defined roles for radiographers, radiologists, referrers and clinical teams

• alignment with IR(ME)R requirements and local governance processes

Implementation is supported at organisational level, recognising that patient safety is a system responsibility, not an individual one.

We recognise the pressures services are under, including workforce constraints, limited access to training time and variable digital infrastructure. We host regular drop-ins to support ongoing feedback and peer learning, and to provide a safe space to share barriers to implementation and seek advice on potential solutions.

Whether you are:

• a radiologist or radiographer

• a service or clinical lead

• a patient safety or governance lead

• part of an imaging academy or education team

• a nutrition nurse or enteral feeding nurse specialist or dietician

We can support you to get started on implementing the NG Tube Position Check Pathway in your service.

Get in touch with us at [email protected] to:

• discuss the pathway in more detail

• understand what implementation involves

• connect with services who have already adopted it

• access support and resources