The Nasogastric Tube in the Thorax after Gastric Pull Up!

Abstract

Although nasogastric tube (NGT) is a simple procedure, the blind placement of nasogastric feeding tubes is not without risks. Chest radiogram is done to confirm the correct position of the NGT. We report a case where radiography could not be confirmatory for the correct position of the tube in a specific group of patients.

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

“…Khanna et al presented a case where the gastric tube position was indeterminate. Even a confirmation by radiograph proved inconclusive; giving the appearance of thoracic malposition when in fact the tube was correctly positioned [ 13 ].…”

“…Tube coiling and knotting were described in 4 case studies with 2 GTs wrapping around endotracheal tubes (ETTs), one self-knotting through a supraglottic device and an intranasal temperature probe/GT entanglement. Acharya et al , Chaudhary et al , and Garg & Kapoor all recount intraoperative events where the GT became entangled around other insitu devices or self knotted preventing unhindered GT removal [ 13 ] [ 14 ] [ 15 ]. The entanglements occurred with an endotracheal tube, a nasopharyngeal temperature probe and an supraglottic airway, respectively.…”

“…Despite a wealth of literature spanning 20 years calling into question its validity and practice alerts made by major associations, two systematic reviews identified it as the most widely used verification method among nurses [ 33 ] [ 34 ]. Parenthetically, four of the GT complication case reports [ 7 ] [ 11 ] [ 12 ] [ 13 ] reviewed used the auscultation technique to verify placement. Nanjegowda [ 11 ] et al and Sahu & Baliarsing [ 7 ] both reported air auscultated over the epigastric although the GT was veritably endobronchial.…”