A case of fatal internal jugular vein perforation during nasogastric tube insertion

Intra-abdominal nasogastric tube placement following inadvertent nasopharyngeal perforation

We report the case of a patient who had a nasogastric tube inserted following cardiac surgery that was determined to be appropriately sited on chest X-ray. Following initiation of nasogastric feeding, however, the patient became acutely unwell. Subsequent computed tomography imaging demonstrated that the nasogastric tube had perforated through the posterior nasopharynx and passed through the mediastinum into the abdominal cavity. A laparotomy and washout was required, and following a prolonged intensive care stay with multiple further interventions, the patient ultimately survived to discharge. Pharyngeal wall perforation is a rare but serious complication of attempted nasogastric tube insertion. Risk factors include the need for repeated attempts and patients with an altered mental state. The appropriate steps in confirming the position of nasogastric tubes both clinically and radiologically are reviewed in the context of this rare and serious complication.

A simple procedure gone wrong: pneumothorax after inadvertent transbronchial nasogastric tube insertion necessitating operative management

Nasogastric tube insertion (NGT) is a common bedside procedure and malpositioned tubes into the tracheobronchial are not uncommon. These can be associated with pulmonary complications. Significantly, pneumothoraces are rare but potential complications that clinicians need to be aware of. We herein report a case of pneumothorax following NGT insertion that necessitated operative management.

A 72-year-old male smoker was undergoing rehabilitation after a recent cerebrovascular accident. A NGT change was done and the chest radiograph done to check placement demonstrated the NGT in the right bronchus with the tip in the right pleural space. The NGT was removed and a new one reinserted. A repeat chest radiograph demonstrated a right sided pneumothorax. He underwent radiologically guided chest drain insertion and subsequently required thoracoscopic surgery where a wedge resection of the right lower lobe was performed. The chest drain was removed on day two post operatively and he made an uneventful recovery.

A new strategy for enteral nutrition using a deflection flexible visual gastric tube: A randomized crossover manikin trial

BACKGROUND

Enteral nutrition via gastric tube insertion is a routine clinical practice for critically ill patients, although complications due to blind manipulation are occasionally reported.

METHODS

An 8.4Fr deflection flexible ureteroscope was delivered into a 15Fr conventional gastric tube to create a gastric visual guidance system. Twenty inexperienced physicians were randomly assigned to perform 5 repeated orogastric tube placements in a manikin using both the conventional method and the deflection visual gastric tube, for a total of 10 procedures per physician. Placement time, procedure-related complications, and participants' experience with both methods were recorded.

RESULTS

Under real-time guidance, the visual gastric tube successfully reached the stomach. The procedure provided additional information on the anatomy of the esophagus and stomach. Placement time was significantly less in the visual group than in the conventional group (39.39 ± 2.11 seconds vs 49.82 ± 3.11 seconds; P < .001). Procedure-related complications were not observed in the visual group; however, the gastric tube was misplaced into the airway in 19 out of 100 cases (19%) in the conventional group. Furthermore, 17 out of 20 participants (85%) preferred the visual gastric tube guide over the standard method.

CONCLUSIONS

Results of this manikin model demonstrate that it is feasible to use the deflection flexible visual gastric tube to create a route for enteral nutrition and that such a procedure decreases placement time and procedure-related complications compared to the conventional procedure. These findings may point to a new strategy for gastric tube insertion in the future.