Synopsis
Trace common thoracic devices from entry to tip, decide whether each is usable, identify immediate complications and communicate a clear corrective action.
- Identify every visible device and trace it continuously from entry point to tip; checking only the tip misses knots, kinks, wrong-lumen course and side holes outside the body.
- For an NG tube film, confirm the current correct patient, adequate lower-centred image, oesophageal course, passage across the diaphragm and tip within the stomach before documenting whether use may proceed.
- If the patient deteriorates or a device course is unsafe or indeterminate, stop using it, treat the complication, escalate directly and obtain further imaging only when it does not delay urgent care.
Key red flags
An endotracheal tube in a main bronchus can cause contralateral collapse, while a tube above the larynx does not protect or ventilate the airway reliably.
Never administer feed or medication through a nasogastric tube until current position has been confirmed and documented by an appropriately trained competent person.
A central venous catheter crossing the midline unexpectedly, coursing cranially, projecting outside expected vessels or associated with new pleural opacity or air must not be used until resolved.
New breathlessness, shock, arrhythmia or surgical emphysema after line or drain placement suggests pneumothorax, haemothorax, perforation or cardiac irritation.
A chest-drain side hole outside the thorax, a kinked tube or a drain directed into a fissure may fail despite an apparently intrathoracic tip.
The tube should descend through the oesophagus, cross the diaphragm centrally and end in the stomach; use requires documented competent review of the current image.
New shock, hypoxia, arrhythmia or pleural change after insertion demands immediate clinical assessment and direct communication before device use.
Investigation priorities
Assess the complete device course, endpoint and immediate thoracic complications.
Management branches
Aspirate pH is unavailable and a lower-centred chest radiograph has been obtained after NG insertion.
- Confirm the current correct-patient film includes the entire tube from upper oesophagus through both hemidiaphragms and is technically adequate.
- Trace the tube down the oesophagus, through the diaphragm and to a gastric tip, making sure it does not follow either bronchial tree.
A portable film contains an airway tube, enteric tube, vascular catheters, drains and cardiac leads.