Accurate confirmation of gastric tube placement is a time-critical safety step in adult intensive care units/emergency department care. Feeding and medication are often urgent, but airway misplacement can be catastrophic. Chest radiography and aspirate pH testing are commonly used; however, they may be slow or unreliable when aspirate is limited, acid suppression is used, enteral feeding is ongoing, or infection-control measures limit imaging. This narrative review summarizes adult evidence on ultrasonography for tube confirmation, with a focus on technique, performance, and safe implementation. When visualization is adequate, ultrasound can support rule-in confirmation, particularly with a standardized two-window approach (cervical esophagus view plus upper abdominal/gastric view) and a small saline/air flush to produce an intragastric acoustic change. However, malposition is uncommon in most studies, and indeterminate scans are frequent in patients with obesity, bowel gas, or postoperative anatomy. Therefore, ultrasound should not be used as a stand-alone test without clear escalation criteria. We propose an ultrasound-first, safety-anchored pathway. The tube should be used only when findings are clearly positive, with escalation to radiography or institutional reference standards when results are inconclusive, discordant, or high-risk. Future pragmatic studies should evaluate time to first feeding/medication and adverse events and standardize protocols and competency targets.
Yang et al. (Mon,) studied this question.