An improperly placed NG tube may be in the trachea, which can be easily determined without re-positioning the tube. If the patient will be unable to produce sound when asked to speak, the tube has been advanced past the vocal cords. After this initial test, the next best approach is to change the position of the tubing then try again, as the tube may be in the patient’s esophagus or duodenum). If these initial techniques are unsuccessful, a chest x-ray may be helpful to determine the location of the tube.