Nasogastric tube depth: the ‘NEX’ guideline is incorrect

Misplacing 17–23% of nasogastric (NG) tubes above the stomach (Rollins et al, 2012; Rayner, 2013) represents a serious risk in terms of aspiration, further invasive (tube) procedures, irradiation from failed X-ray confirmation, delay to feed and medication. One causal factor is that in the National Patient Safety Agency (NPSA) guidance to place a tube, length is measured from nose to ear to xiphisternum (NEX) (NSPA, 2011); NEX is incorrect because it only approximates the nose to gastro-oesophageal junction (GOJ) distance and is therefore too short. To overcome this and because the xiphisternum is more difficult to locate, local policy is to measure in the opposite direction; xiphisternum to ear to nose (XEN), then add 10 cm. The authors determined whether external body measurements can be used to estimate the NG tube length to safely reach the gastric body. This involved testing the statistical association of body length, age, sex and XEN in consecutive critically ill patients against internal anatomical...