Study supports image-guided NG tube checks in dogs and cats
Bottom line
Version 1
A new retrospective study in the Journal of Veterinary Emergency and Critical Care evaluated a standardized, image-guided nasogastric tube placement protocol in 582 dogs and cats and found it prevented inappropriate airway placement in 99.8% of cases when clinicians used radiographic verification at the thoracic inlet and last rib. The protocol also identified initial tracheal placement in 9.8% of cases, underscoring how often misdirection can occur before confirmation. The paper adds to a growing body of work around safer enteral tube placement in small animal practice, including newer radiographic guidance tools designed to improve interpretation of tube position in dogs and cats. (pmc.ncbi.nlm.nih.gov)
Why it matters: For veterinary teams, the takeaway is straightforward: blind confidence in tube placement isn’t enough. Prior research has shown respiratory misplacement can occur even when other bedside checks seem reassuring, and a 2024 randomized trial found radiography remained the reference standard because no point-of-care technique was fully concordant with thoracic imaging. Separate outcome data in dogs with tracheobronchial misplacement-associated pneumothorax highlight how serious these errors can become. In that context, a protocol that catches nearly 1 in 10 initial tracheal placements before use is highly relevant for emergency, critical care, and inpatient teams managing anorexic or critically ill patients. (pubmed.ncbi.nlm.nih.gov)
What to watch: Expect more discussion around how standardized radiographic checklists and image-guided protocols can be integrated into general practice and ER workflows, especially as newer 2026 radiographic guidelines gain traction. (vetsurgeon.org)
Version 2
A retrospective study covering 582 dogs and cats reports that a standardized, image-guided nasogastric tube placement protocol prevented inappropriate airway placement in 99.8% of cases, adding fresh evidence for a stricter, imaging-based approach to feeding tube safety in small animal medicine. According to the study abstract, radiographic verification at the thoracic inlet and last rib was central to the protocol, and initial tracheal placement was detected in 9.8% of cases before final confirmation. (pmc.ncbi.nlm.nih.gov)
That matters because nasogastric and nasoesophageal tubes are common tools in hospitalized dogs and cats, but misplaced tubes can cause aspiration pneumonia, pulmonary hemorrhage, or pneumothorax. The field has been moving toward more formalized safeguards. In a 2024 randomized controlled trial of 97 animals, respiratory tract misplacement occurred in 3.1% of placements, and the authors found that no bedside confirmation method was completely concordant with radiography. More recently, a 2026 multi-institutional study from the Royal Veterinary College introduced a three-point radiographic checklist to standardize interpretation of tube position on lateral neck and thoracic views. (pubmed.ncbi.nlm.nih.gov)
The new 582-case study appears to reinforce the same practical message from a different angle: protocolization matters, and so does image review. Based on the abstract, the protocol relied on radiographic checkpoints at two anatomic levels and achieved near-complete prevention of airway placement when followed. Just as important, it identified almost 1 in 10 tubes as initially entering the trachea, suggesting that airway misdirection during placement may be more common than many clinicians assume, even if final adverse events are infrequent. (pmc.ncbi.nlm.nih.gov)
The broader literature helps explain why this is clinically important. A 2023 study in cats found ultrasonography was promising for confirming esophageal placement, but radiography was still described as the gold standard. Meanwhile, published outcome data on dogs with pneumothorax after nasogastric tube misplacement into the tracheobronchial tree show the downstream consequences can be severe, including death in some cases. Taken together, the newer retrospective data support a low-threshold approach to imaging confirmation rather than relying on historical bedside techniques alone. (frontiersin.org)
Industry and professional reaction around tube-checking has been moving in the same direction. Coverage of the RVC’s 2026 guideline paper emphasized that clinicians’ diagnostic accuracy improved from 82% to 96% after using a simple three-point radiographic checklist, while uncertainty dropped from 14% to 2%. Those guidelines were designed to be practical in real-world settings, including general practice, by using a single lateral cervical-thoracic radiograph that includes the larynx and thorax. While that study focused on image interpretation rather than placement technique itself, its reception suggests strong appetite for standardized, teachable safeguards around enteral tube use. (vetsurgeon.org)
Why it matters: For veterinary professionals, this study supports building tube placement safety into the workflow, not treating confirmation as a final formality. Emergency and critical care teams, interns, technicians, and general practitioners all place or manage these tubes, and the data suggest that a meaningful share of first-pass placements may enter the airway before correction. Standardized imaging protocols can reduce variation between clinicians, strengthen training, and potentially lower the risk of catastrophic complications for hospitalized dogs and cats whose pet parents already face high-acuity decisions. (pmc.ncbi.nlm.nih.gov)
What to watch: The next step is likely wider adoption and comparison of standardized confirmation strategies, including how this 582-case protocol aligns with newly published radiographic checklists, capnography-assisted approaches, and ultrasound-based verification in different hospital settings. (vetsurgeon.org)