Misplacement of Nasogastric Tubes and Oesophageal Monitoring Devices

Sweatman, A.J.; Tomasello, P.A.; Loughhead, Michael G.; Orr, Marisa K.; Datta, Taniya

doi:10.1093/bja/50.4.389

Cited by 42 publications

(10 citation statements)

References 10 publications

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“…The routine way for NGT insertion is its blind insertion while the patients head is in the neutral position with an approximate success rate of 40-58% [17][18][19]. Although common techniques for NGT insertion are lateral neck pressure, head flexion, freezing the NGT before its insertion, anterior larynx displacement, slit ETT as introducer, as well as lateral head positioning, none of them has reported high success rate [17][18][19][20][21] (Table 1). For the first time, Siegel et al showed that a nasopharyngeally placed endotracheal tube could facilitate the insertion of a difficult nasogastric tube [55].…”

Section: Insertion Techniquesmentioning

confidence: 99%

“…Using macintosh laryngoscope or glidescope with assistance of magill forceps [26,27] Ultrasonography Nose bleed Infectious complications [10] Neck flexion Uretral guidewire [25] Nex method [14,15] Sinusitis [46] And intracranial placementand central nervous system complications [48] Lateral head positioning I-gel [28,29] Under water vaccum effect [35] Parotitis [46] Nose erosion/ /nasal aral necrosis [49] Anterior displacement of the mandible (and a group of older techniques) [21] Proseal LMA [28,29] Aspirate colors [35] Sore throat Laryngeal edema with asphyxia…”

Section: By Equipment Minor Majormentioning

confidence: 99%

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Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Sanaie

Mahmoodpoor

Najafi

2017

Anaesthesiol Intensive Ther

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Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.

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Section: Insertion Techniquesmentioning

confidence: 99%

Section: By Equipment Minor Majormentioning

confidence: 99%

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Sanaie

Mahmoodpoor

Najafi

2017

Anaesthesiol Intensive Ther

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“…The Steen technique, which, with some modifications, involves passing the NG tube through an endotracheal tube already inserted into the esophagus, is favored by some authors (4, 5). The finger-guided method (6) and puffing technique (7) have also been reported to be successful. However, because these are all blind techniques, these measures can be traumatic and unreliable.…”

Section: Casementioning

confidence: 99%

“…Because of the reshaping force culties in inserting NG tubes, not always in comatose or anesthetized patients (l), but also in conscious patients in whom normal anatomy above the cricopharyngeous muscle is distorted. A variety of measures that facilitate insertion have been mentioned in the literature (1)(2)(3)(4)(5)(6)(7). To overcome the flexibility of NG tubes, not only chilling the tube, but also Fogarty catheters (I), guitar strings (4, and stainless steel spring guides (3) have been advocated as stylets to increase the tube's stiffness.…”

Section: Casementioning

confidence: 99%

“…However, because these are all blind techniques, these measures can be traumatic and unreliable. Inadvertent intracranial introduction of a NG tube (8), as well as cases of unintentional insertion of the NG tube into the trachea alongside a cuffed endotracheal tube, have been described (6,9 ) . Insertion of a NG tube under direct vision has been emphasized to avoid these complications (8,9 ) .…”

Section: Casementioning

confidence: 99%

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Flexible Fiberoptic Bronchoscope for Difficult Nasogastric Intubation

Lee¹,

Wright²

1981

Anesthesia & Analgesia

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Insertion of a nasogastric (NG) tube is widely used for gastrointestinal decompression or for feeding in critically ill patients. It is not uncommon to experience difficulties in inserting the NG tube under certain circumstances during this relatively simple procedure, particularly when an endotracheal (ET) tube is already in place. A frequent problem is failure to get the NG tube into the esophagus. Various tactics have been described to facilitate the procedure. We present a technique using a flexible fiberoptic bronchoscope (FFB) and guide wire for inserting the NG tube into the esophagus under direct visualization. When all other efforts fail, the FFB may provide a recourse for resolving the problem. MethodExplanation of the procedure may relieve anxiety and win cooperation of the patient. The inferior meatus of the nasal cavity is first anesthetized with a mixture of 2% viscous lidocaine and 5% cocaine on a cotton applicator. The well lubricated FFB is then introduced into the oropharynx along the nasaI floor Director, Critical Care Services. 904ANESTHESIA AND ANALGESIA VoI 60, No 12. December 1981 as in routine bronchoscopy. The hypopharynx is examined and anesthetized with 2 ml of 4% lidocaine. The tip of the FFB is then carefully directed into the slit between the interarytenoid glottis and posterior wall of the pharynx under direct vision.With mild steady pressure the FFB is gently advanced; a sudden decrease of resistance can be felt as it enters the esophagus. The FFB (Olympus, BF type IT, diameter 5.9 mm, length 56 cm, suction channel 2.6 mm) is then advanced slowly under intermittent visualization of the esophageal lumen until the whole length of the FFB is passed. The position of the tip can be ensured by auscultation when 10 to 20 ml of air is injected through the suction channel. A guide wire (Amplatz heparin coated, Cook Inc, type TSF, diameter 35 mm i.d., length 145 cm) is then threaded through the suction channel into the stomach (Figure).The FFB is subsequently withdrawn and the wire left in place. An appropriately sized NG tube, well lubricated, can then be passed over the guide wire into the stomach. The position of the NG tube can be rechecked by routine aspiration, air injection, and x-ray examination. Passing the entire length of the FFB, as well as the guide wire into the stomach, ensures a smooth insertion of the NG tube. Any possible difficulty in passing the esophagus due to pliability of the NG tube will be eliminated. Case Reports Case 1A 32-year-old man sustained a cervical spine (C3-4) fracture after an automobile accident. He had an endotracheal tube in place and was being mechanically ventilated because of quadriplegia and respiratory failure. Crutchfield tong traction was applied. Placement of a NG tube was attempted many times; various methods, including stiffening the tube with ice water, using a guide wire, and blind insertion of an endotracheal tube as an introducer, failed to place anything in the esophagus. The FFB technique was used with success. Direct visualization of ...

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Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention

Roubenoff

Ravich²

1989

Archives of Internal Medicine

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Misplacement of Nasogastric Tubes and Oesophageal Monitoring Devices

Cited by 42 publications

References 10 publications

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

Flexible Fiberoptic Bronchoscope for Difficult Nasogastric Intubation

Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention

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