Small-bore, silicone nasoenteric feeding tubes are increasingly utilized in the critically ill patient to provide nutritional support. The metallic-weighted tips and stiffening introducing stylets create the potential for misplacement with potentially serious consequences. We have reported our experience with 14 patients who had inadvertent tube misplacement, resulting in complications that included pneumothorax, hydrothorax, empyema, mediastinitis, pneumonia, and esophageal perforation. The incidence of radiographically detected abnormal tube position was 1.3 percent. The presence of cuffed tracheostomy or endotracheal tubes did not prevent this occurrence. The institution of enteral feedings should, therefore, be performed according to strict guidelines which include radiographic confirmation of desired position before feedings are initiated, limited and supervised use of stylets, and a need for special precautions in patients who are obtunded or receiving intubated respiratory assistance.