Nasoenteric Tube Complications

Abstract

the use of nasoenteric tubes (Nets) is ubiquitous, and clinicians often take their placement, function, and maintenance for granted. Nets are used for gastrointestinal decompression, enteral feeding, medication administration, naso-biliary drainage, and specialized indications such as upper gastrointestinal bleeding. morbidity associated with Nets is common, but frequently subtle, mandating high index of suspicion, clinical vigilance, and patient safety protocols. common complications include sinusitis, sore throat and epistaxis. more serious complications include luminal perforation, pulmonary injury, aspiration, and intracranial placement. Frequent monitoring and continual re-review of the indications for continued use of any Net is prudent, including consideration of changing goals of care. this manuscript reviews Net-related complications and associated topics.

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

“…Ultrasonography [30] Ph indicator [36,37] Stridor [47] Pulmonary aspiration [50] Sort maneuver [22,23] Airway scope [31] Electromagnetic device [38] Pneumothorax [51] Nelaton [32] Chemical assessment of aspirates (Ph, trypsin, bilirubin, CO 2 and pepsin) [39,40] Perforation of lamina cribrosa [52] Tube length End tidal CO 2 monitoring [41] Retropharyngeal abcess [47] Fluroscopy [42] Stricture formation Endoscopy [42] Aortoesophageal fistula [52] Manometer [43,44] Nasogastric tube syndrome [53,54] (TEE) probe insertion (See video at: http://atlasofscience. org/nasogastric-tube-insertion-the-simple-yet-impossible/ accessed 11 Nov 2016).…”

“…Parotitis, perforation of lamina cribrosa and retropharyngeal abscess are other complications related to NGT [47,84]. Moreover, there have been some reports about the stricture formation, aortho-esophageal fistula and submucosal passage [52]. Brousseau et al [53] reported a rare but life threatening complication of NGT which is characterised by bilateral vocal cord paralysis and supraglottic oedema following NGT insertion.…”

“…If one is unable to approve the correct placement after these evaluations, a chest x-ray is necessary. A radiologic assessment is also necessary for critically ill patients and patients with swallowing problems [52,86]. Powers et al [38] showed that use of an electromagnetic device could help one to assess correct NGT placement at the bedside.…”

Mechanical Complications of Nasoenteric Tubes

“…Although the overall literature on the topic is relatively scant, there is a significant association between NETs and sinusitis (Prabhakaran et al 2012). There seems to be a spectrum of clinical and subclinical sinus involvement in the patient Fig.…”

“…Independent risk factors for sinusitis in the intensive care setting include nasal colonization with enteric gram-negative bacilli, sedation, depressed mental state (i.e., GCS >7), and feeding via NET (George et al 1998). Based on this information, minimizing the NET dwelling times is perhaps the best preventive strategy and may also help reduce the risk of pressure-related injuries to the nasal area as well as erosive changes associated with mucosal irritation (Prabhakaran et al 2012).…”