Misplacement of nasogastric tube in two different cases: Case report

Abstract

Abstract. Although the insertion of nasogastric tube has been described as an easy and simple procedure, it may cause severe complications and death. It is therefore important to verify correct nasogastric tube placement. Placement of a nasogastric tube is confirmed using several methods, including auscultation over the epigastric area, aspiration of gastric content from the tube, measuring pH of gastric content and radiological methods. We present the inadvertent insertion of nasogastric tube into the airways, that resulted in respiratory distress, in two different patients to serve as a reminder that malpositioning may cause severe complications.

Keywords

• Complication
• nasogastric tube
• respiratory distress
• pneumothorax

References

1. Rippe JM, Irwin RS, Alpert JS, Fink MP. Gastroenterologic problems in the intensive care unit. In: Clouse RE, editor. Intensive Care Medicine. United States of America: Little, Brown and Company 1991; 903.
2. Umuroğlu T, Doğan İV, Yaycı A. Misplacement of a nasogastric tube into the postpneumonectomy space. Marmara Medical Journal 2004; 17: 78-80.
3. Pillai JB, Vegas A, Brister S. Thoracic complications of nasogastric tube: review of safe practice. Interact Cardiovasc Thorac Surg 2005; 4: 429-433.
4. Ferreras J, Junquera LM, Garcia-Consuegra L. Intracranial placement of a nasogastric tube after severe craniofacial trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90: 564-566.
5. Sparks DA, Chase DM, Coughlin LM, Perry E. Pulmonary complications of 9931 narrow-bore nasoenteric tubes during blind placement: A critical review. J Parenter Enteral Nutr 2011; 35: 625-629. Kim HM, So BH, Jeong WJ, Choi SM, Park KN. The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center. Scand J Trauma Resusc Emerg Med 2012; 20: 38.
6. Taylor SJ. Confirming nasogastric feeding tube position versus the need to feed. Intensive and Critical Care Nursing 2013; 29: 59-69.
7. Rassias AJ, Ball PA, Corwin HL. A prospective study of tracheopulmonary complications associated with the placement of narrow-bore enteral feeding tubes. Crit Care 1998; 2: 25
8. Kawati R, Rubertsson S. Malpositioning of fine bore feeding tube: a serious complication. Acta Anaesthesiol Scand 2005; 49: 58-61.

9. Roubenoff R, Ravich WJ. Pneumothorax due to nasogastric feeding tubes: report of four cases, review of the literature and recommendations for prevention. Arch Intern Med 1989; 149: 184-188.
10. Takwoingi YM. Inadvertent insertion of a nasogastric tube into both main bronchi of an awake patient: a case report. Cases Journal 2009; 2: 6914. Ibarra-Perez C. Lung perforation by a small-bore enteral feeding tube. Rev Invest Clin 1992; 44: 2552
11. Lee JH, Lee YD, Na DJ. Kink of a Nasogastric Tube in the Bronchial System without Complications. Respiration 2010; 79: 420.
12. Metheny N, McSweeney M, Wehrle MA, Wiersema L. Effectiveness of the auscultatory method in predicting feeding tube location. Nurs Res 1990; 39: 262-2