Following new research, the Royal Veterinary College (RVC) has introduced guidelines to help veterinarians safely check feeding tube placement in dogs and cats. Feeding tubes are commonly used in veterinary medicine, but incorrect placement can have severe and potentially fatal consequences.
While radiographs are routinely used to check tube position, this is the first time standardised guidelines have been developed to support veterinarians to make informed and accurate decisions.
Tube feeding is widely used in both human and veterinary medicine to support patients with illness and reduce mortality, with nasoesophageal (a tube passed through the nose into the oesophagus) and nasogastric (a tube passed through the nose into the stomach) tubes commonly used in dogs and cats. However, until now, there has been no published guidance on precise radiographic criteria for determining correct tube placement, making interpretation uncertain and potentially leading to complications, including aspiration pneumonia (lung infection) and pneumothorax (collapsed lung). By addressing this gap, the study aimed to create a practical approach to help both first opinion and referral veterinarians assess feeding tube placement more accurately and with greater confidence.
Led by Andrea Vila Cabaleiro, Small Animal Diagnostic Imaging Resident at the RVC, the research team collected 256 lateral neck and chest radiographs of dogs and cats with nasoesophageal or nasogastric feeding tubes in place. The images were sourced from ten private and academic institutions, including the RVC’s Queen Mother Hospital for Animals. Expert veterinary radiologists then verified whether the tubes were correctly placed in the oesophagus (food pipe) or incorrectly in the trachea (windpipe).
Radiographic guidelines were created to help determine the correct placement of the feeding tubes. These guidelines offered an easy-to-use 3-point system to confirm placement:
- Does the tube pass dorsal to cricoid cartilage lamina (larynx)
- Is at least some part of the tube journey visible outside the trachea (i.e. not complete superimposition with the trachea)
- Does the tube pass dorsal to the dorsal wall of the carina
To validate the usefulness of the new guidelines, six veterinarians with varying levels of clinical experience each reviewed the same radiographs on two occasions: initially using their prior judgement before seeing the radiographic guidelines, and again at least seven days later, after being introduced to the new radiographic guidelines. The two sets of results were then compared to evaluate whether the guidelines had improved accuracy and confidence in interpreting tube placement.
The findings showed a dramatic improvement in diagnostic accuracy following the introduction of the guidelines, with correct identification of tube placement increasing from 82% to 96%. In addition, the results showed a sharp reduction in diagnostic uncertainty, which fell from 14% of assessments where the assessor was unable to decide on the placement of the tube to just 2%. These results indicate that clinicians using the guidelines were not only more accurate but also more confident in their decisions. Notably, these improvements were observed across clinicians with varying levels of experience, from trainees to experienced practitioners.
The researchers also found that agreement between clinicians improved from moderate to almost perfect once the guidelines were used, demonstrating that the guidelines effectively standardise how radiographs are interpreted. Importantly, the guidelines were consistently effective across both dogs and cats, a wide range of patient sizes and multiple clinical settings, highlighting their broad applicability in everyday veterinary practice.
Taken together, these findings show that a structured and evidence-based approach based on these new radiographic guidelines can significantly improve the safety and reliability of feeding tube placement in dogs and cats. By focusing on easily identifiable radiographic features, the guidelines provide a rapid and practical method that requires no additional equipment or specialist technology, making them well-suited for use in general practice as well as in emergency and critical care settings where timely decision-making is essential.
To assist with the uptake of the new radiographic guidelines, an easy-to-use infographic has been created to lead veterinarians through the three steps. As these guidelines become more widely adopted, further evaluation can help determine their long-term impact on clinical outcomes, with the findings hopefully collectively supporting safer, more consistent care for hospitalised dogs and cats across a range of veterinary settings.
Andrea Vila Cabaleiro, Small Animal Diagnostic Imaging Resident at the RVC and lead author of the paper, said: “I am incredibly excited about the publication of this paper, which helps veterinarians prevent life-threatening consequences associated with feeding tube misplacement. I am proud to share these guidelines, which support safer, more confident decision-making in everyday practice.”
Francisco Llabres-Diaz, Senior Lecturer in Veterinary Diagnostic Imaging at the RVC and supervisor for Cabaleiro, said: “This multicentre collaboration between the RVC and other clinical teams has developed and successfully demonstrated the advantage of using a novel set of easy and practical guidelines to confirm the correct positioning of feeding tubes. Fatal complications from the incorrect positioning of such tubes on usually already very sick patients can be catastrophic. These guidelines could potentially have a very significant positive impact on clinical practice for years to come. The whole diagnostic imaging team at the RVC is delighted with the outcome.”
Dan O’Neill, Professor of Companion Animal Epidemiology at the RVC and co-author of the paper, said:“This paper shows the power of good data and study design to create useful new tools that enhance contextualised veterinary care. These new radiographic guidelines will save lives – and that is what good research should do.”
