Rare and dangerous complication of nasogastric tube insertion

Leow, Tze Hao; Lam, Stephen; Kumar, Bhaskar

doi:10.1136/bcr-2020-235677

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…The patients who choose NJ indwelling feeding tube for enteral nutrition therapy are significantly more advantageous than those using a NG indwelling feeding tube. For those critically ill patients at high risk of aspiration, the guidelines recommend post-pyloric feeding ( 7 ). Post-pyloric feeding can better improve nutritional status, and reduce gastric retention and inhalation ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation

et al. 2022

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BackgroundCompared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported.ObjectiveWe tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients.MethodsA total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates.ResultsThe primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05).ConclusionCompared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.

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Section: Introductionmentioning

confidence: 99%

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation

et al. 2022

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“…This can subsequently lead to pneumothorax, lung lacerations, lung collapse and diaphragmatic injury 9. Patients who are at particular risk of complications include those with neurological impairment, abnormal gastrointestinal anatomy, endotracheal intubation or dysphagia of any cause 10 11…”

Section: Discussionmentioning

confidence: 99%

“…A repeat CXR may help identifying new changes. If in doubt, the position of the NG tube can be confirmed using a CT scan or by direct visualisation with oesophageogastroduedonoscopy 11. CT can also confirm the presence of iatrogenic pleural effusion, which would necessitate drainage with intercostal chest drains.…”

Section: Discussionmentioning

confidence: 99%

Nasogastric tube placement perforating the nasopharynx causing mediastinal passage and feeding into the pleural space

Zafran,

Crook,

Tuck

et al. 2024

BMJ Case Rep

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A mid-60s female with known primary progressive multiple sclerosis was admitted to our hospital with aspiration pneumonia. Due to reduced consciousness, a nasogastric (NG) tube was inserted for feeding. A chest x-ray (CXR) report from a thoracic radiologist confirmed an atypical tip position due to a hiatus hernia but concluded it was almost certainly within the stomach. However, after deteriorating on feed commencement, a CT scan of the chest confirmed the tube had perforated the nasopharynx and run parallel to the oesophagus through the mediastinum into the right pleural space. The patient subsequently developed an empyema and pneumothorax, requiring multiple therapeutic interventions and a prolonged hospital stay. This case demonstrates how the routine insertion of an NG tube can lead to serious complications. Additionally, position check CXRs can be difficult to interpret, so the decision to use the tube must be made cautiously by the clinical team.

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“…There are many known contributors to incorrect NGT intubation, including the intubation length of the NGT tube (Chen et al, 2014), patient positioning (Jonnavithula, Padhy, Ravula, & Alekhya, 2019; Sanaie et al, 2020), tube hardness (Mazlom, Firouzian, Norozi, Ghasemi Toussi, & Marhamati, 2020), and the intubation technique (Mandal et al, 2014). Incorrect placement leads to many known complications including pain (Uri, Yosefov, Haim, Behrbalk, & Halpern, 2011), tubing kinks (Jonnavithula et al, 2019; Mandal et al, 2014), mucosal tears (Jonnavithula et al, 2019; Mandal et al, 2014), tracheal intubation (Guthrie, Pezzollo, Lam, & Epstein, 2020; Jonnavithula et al, 2019; Leow, Lam, & Kumar, 2020), bleeding (Guthrie et al, 2020; Jonnavithula et al, 2019; Leow et al, 2020), aspiration pneumonia (Honda, Momosaki, & Ogata, 2020; Khan et al, 2020; Turgay & Khorshid, 2010), or death (Honda et al, 2020; Khan et al, 2020; Turgay & Khorshid, 2010).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Positioning in Unconscious Adults During Nasogastric Intubation on Correct Placement and Intubation Time

Chen

Hung

et al. 2022

Gastroenterology Nursing

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Nasogastric intubation is a common procedure in hospitals that causes adverse outcomes if performed incorrectly. There is currently insufficient guidance for patient positioning, which increases the success of nasogastric intubation at the bedside. Therefore, a systematic review with a meta-analysis was performed to determine the effectiveness of changing an unconscious adults' positions compared with the supine position to improve the correct placement of a nasogastric tube, intubation time, and complications. The Cochrane Library, MEDLINE, Embase, PubMed, and CINAHL databases were searched from inception to April 2019 for randomized controlled trials. The Cochrane Collaboration Risk of Bias tool was used to assess the quality of eligible studies. Cochrane Review Manager 5.3 software was used to analyze the data. A total of 288 articles were obtained in the literature search, 10 of which were included in the analysis. Most of the included trials were at low risk of bias. All postures were significantly effective, though neck flexion had the highest success rate (odds ratio = 4.87, 95% confidence interval [2.48, 9.57], Z = 4.6, p < .00001, I2 = 0%) for nasogastric intubation. In terms of the time required for the procedure, compared with the usual posture, although the total effects were significant (MD =−10.33, 95% confidence interval [−15.38, −5.29], Z = 4.02, p < .00001, I2 = 98%), only neck flexion and lifting of the larynx reduced the time. The meta-analysis suggests that patient positioning improves the success rate of nasogastric intubation and increases safety. Finally, the authors developed a procedural instruction sheet to aid practitioners with nasogastric intubation.

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Rare and dangerous complication of nasogastric tube insertion

Cited by 3 publications

References 9 publications

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation

Nasogastric tube placement perforating the nasopharynx causing mediastinal passage and feeding into the pleural space

Effectiveness of Positioning in Unconscious Adults During Nasogastric Intubation on Correct Placement and Intubation Time

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