Naughty knot: a case of nasogastric tube knotting

Abstract

Nasogastric intubation is a common procedure for enteral nutritional support in medical practice. Random spontaneous true knot formation in the tube is rarely encountered and is a cause of unanticipated trauma. This is a case of a true knot formation diagnosed with fluoroscopy and managed without untoward trauma.

Knot the Best Scenario: A Case of a Knotted Nasogastric Tube

“…To our knowledge, most case reports of nasogastric tube knotting do not find that the function of the tube in situ was to blame. Rather, the knot is discovered—as it was in our case—when clinicians encountered resistance in attempting to remove the tube 4-9. In a few cases, clinicians reported discovering knotting during nasogastric tube removal due to tube blockage10, 11 or because tube placement could not be confirmed via air insufflation and aspiration 12.…”

“…By Peijin Esther Monica Fan, BSc, RN, Kai Yunn Teo, BNurs, RN, Min Yi Tan, BNurs, RN, and Shin Yuh Ang, MBA, BSc, RN covered-as it was in our case-when clinicians encountered resistance in attempting to remove the tube. [4][5][6][7][8][9] In a few cases, clinicians reported discovering knotting during nasogastric tube removal due to tube blockage 10,11 or because tube placement could not be confirmed via air insufflation and aspiration. 12 These findings corroborate more recent claims that knotting occurs during nasogastric tube insertion and that the traction caused by its removal tightens the knot.…”

"Gastric Regurgitation During Induction of Anesthesia Due to Inadequate Drainage of the Nasogastric Tube: A Case Analysis"

“…Blockage of the nasogastric tube is an easily underestimated complication and is particularly common when thicker enteral feeds, bulking agents and medications are delivered through relatively small nasogastric tubes [9]. Many case reports have shown that excessively long cannulae tend to lead to nasogastric tube kinking [10][11][12]. Prevention is a key factor in the treatment of nasogastric tube blockage.…”

Removal of Knotted Nasogastric Tube: A Literature Review and Lessons From Our Case

“…Although nasogastric tube insertion is a routine procedure, it can cause unexpected complications, including as-piration, perforation of vascular structures, pneumothorax, epistaxis, tracheal or intracranial misplacement, and a retained nasogastric tube. 3) Severe complications have rarely been reported, and the associated mortality rate has been reported to be 0.3%. 3)4) The majority of complications, including true knot formation, are due to faulty insertion of the tube.…”

“…3)4) The majority of complications, including true knot formation, are due to faulty insertion of the tube. 3) Several risk factors potentially associated with nasogastric tube knot formation upon tube insertion have been reported, including the use of narrow-bore tubes, excessive tube length, small bursts of violent peristalsis, prolonged duration of tube placement. Furthermore, patients with head trauma or small gastric remnant induced by previous gastric surgery could be also risk factors of nasogastric tube knotting.…”