New radiographic guidelines for feeding tubes in dogs and cats

Enteral nutrition is a central component of therapy in dogs and cats with insufficient voluntary food intake. Naso-oesophageal (NE) and nasogastric (NG) tubes are part of everyday clinical practice – however, incorrect placement carries the risk of serious complications.

Although radiographic confirmation of tube position is considered the gold standard, standardized assessment criteria have so far been lacking.

In the 2026 paper by Andrea Vila Cabaleiro et al., entitled “Introduction and validation of radiographic guidelines for identification of nasoesophageal and nasogastric tube position in dogs and cats,” validated and reproducible criteria for the radiographic evaluation of tube placement in dogs and cats are now defined.

We have reviewed the paper and summarized several interesting and clinically relevant points for you:

The guideline defines three main radiographic landmarks:

1. Dorsal tube position at the level of the larynx:
   If the cranial cervical region is included in the radiograph, the tube should course dorsally to the larynx. When visible, the lamina of the cricoid cartilage (cartilago cricoidea) may be used as an anatomical landmark.
2. No complete superimposition with the tracheal lumen:
   The tube should be radiographically distinguishable from the trachea and must not completely overlap the tracheal lumen.
3. Dorsal tube position in relation to the carina:
   On the lateral projection, the tube should run dorsally to the carina. This confirms oesophageal placement.
    

Two additional important findings from this study, which evaluated a total of 256 radiographs, are the importance of including the larynx on the radiographs and the recognition of tracheal misplacement of feeding tubes.
Before the introduction of the guideline, correct assessment of tube position was significantly higher when the larynx was included in the image (89.1% vs. 77.5%). After implementation of the standardized criteria, this difference disappeared, as in particular
– the criterion of “no complete superimposition with the trachea” and
– the “dorsal tube position in relation to the carina”
provided high diagnostic certainty even without visible laryngeal structures.

Tracheal misplacements were frequently recognised as abnormal prior to the introduction of the guideline; however, in 19.4% of cases they were classified as “uncertain.” After application of the guideline, this proportion decreased to 4.1%. This demonstrates that the standardized criteria provide decisive added value, particularly in cases where clinical caution previously led to diagnostic uncertainty.
 

Clinical relevance:
Systematic radiographic confirmation before initiating enteral nutrition should be considered standard practice. The guideline offers a structured and easy-to-implement checklist for this purpose.