To explore a simple and safe method to enhance the success rate of nasojejunal tube placement in neurocritical care patients.Methods A total of 115 neurocritical care patients requiring nasojejunal tube placement were chronologically divided into two groups.During sonographic procedure, position of the tube in the control group (n=66) was confirmed using the standard short-axis ultrasonic view of the gastric pylorus and calculating the number of cross-sections of the tube, while that in the observation group (n=49) was confirmed by making surface marks from ultrasound images when the tube was visualized at some specific anatomical points.The success rate, placement time, efficacy of conforming tube positioning, treatment costs, and complications were compared between the two groups.Results The total success rate of tube placement in the observation group was 97.96%, with a first-attempt success rate of 87.76%, and the average number of placements was 1.12±0.33, with placement time of 30(30,50)min.Those in the control group were 86.36%, 62.12%, 1.38±0.63, and 60(40,70)min, respectively.The observation group showed significant improvements in the above-mentioned parameters compared to the control group (all P＜0.05).The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy in the observation group were 83.33%, 100.00%, 97.73%, 100.00%, and 97.96%, respectively, while in the control group were 64.00%, 92.68%, 80.85%, 84.21%, and 81.82%, respectively.The total treatment costs and the incidence of gastrointestinal bleeding in the observation group were significantly lower than those in the control group (both P＜0.05).Conclusion Surface marking combined with real-time ultrasonography may confirm the correct positioning of nasojejunal tube in neurocritical care patients, resulting in reducing treatment costs and offering better safety.