Introduction and Validation of Radiographic Guidelines for Identification of Nasoesophageal and Nasogastric Tube Position in Dogs and Cats

Nasoesophageal and nasogastric feeding tubes are commonly used in dogs and cats, but inadvertent tracheal placement can cause serious complications. Although radiographs are widely used for confirming tube position, standardized interpretive guidelines are lacking. This study aimed to introduce and validate novel radiographic guidelines for improving tube position identification. Six blinded interpreters (one radiology intern, two emergency and critical care residents, one general practitioner, and two fourth-year veterinary students) with varying clinical experience assessed tube positioning on 256 lateral canine and feline cervical/thoracic radiographs before and after receiving the guidelines. True tube position was determined by clinical history and radiographic assessment by two board-certified radiologists. The proposed guidelines for identifying correctly positioned tubes included (1) incomplete superposition of the tube on the tracheal lumen, (2) dorsal tube position relative to the carina, and (3) relative to the larynx when included. The study included 129 esophageal-positioned (correct) and 127 tracheal-positioned (incorrect) radiographs with nasoesophageal/nasogastric tubes. The implementation of the radiographic guidelines significantly improved the correct identification of tube positioning, increasing from 82.1% pre-guidelines to 95.8% post-guidelines (p < 0.001). Additionally, "uncertain" assessments decreased from 14.1% pre-guidelines to 2.4% post-guidelines (p < 0.001). Before guidelines, interpreters correctly identified tube position in 89.1% of radiographs that included the larynx. However, guideline implementation did not significantly impact the correct interpretation of tube position assessment when the larynx was included. These results validate the clinical utility of a novel radiographic guideline to improve the accuracy and confidence of identification of nasoesophageal/nasogastric tube position in dogs and cats.