Bedside Ultrasonography-Guided Nasogastric Tube Placement: A Narrative Review

Objectives: This narrative review aimed to synthesize available evidence on procedures used for bedside ultrasonography-guided verification of nasogastric tube (NGT) placement. Methods: A comprehensive search was conducted in five databases, supplemented by gray literature and clinical guidelines, without restrictions on language or publication year. Eligible studies focused on ultrasound-guided NGT insertion or verification in adults. Data were extracted and synthesized descriptively using the I-AIM framework (Indication, Acquisition, Interpretation, and decision-Making). Results: 29 studies were included, most of them observational and conducted in intensive care or emergency settings. Ultrasound was primarily indicated for enteral nutrition, with gastric decompression less frequently reported. Acquisition protocols varied, though supine positioning, convex abdominal probes, and linear cervical probes were most common. The gastric antrum and esophagus were the main landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally employed. Radiography remained the reference standard in over 90% of studies, though a few initiated feeding based on ultrasound alone. Facilitators included bedside feasibility, absence of radiation, and timeliness, whereas barriers encompassed operator dependency, limited visualization in patients with obesity or gas interposition, and heterogeneity of protocols. Conclusions: Ultrasonography is a promising, safe, and innovative method for NGT verification that can reduce delays, avoid radiation exposure, and improve patient safety. With structured training, nurses can achieve accuracy comparable to physicians, supporting greater autonomy in clinical decision-making. Standardized protocols and integration into nursing education are essential to ensure reliable and widespread adoption.