Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-29T07:45:32.424Z Has data issue: false hasContentIssue false

A case of a ‘lost’ nasogastric tube

Published online by Cambridge University Press:  26 October 2012

V Sankar*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, UK
M Shakeel
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, UK
S Keh
Affiliation:
Department of Otolaryngology, St John's Hospital, Edinburgh, Scotland, UK
K W Ah-See
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, UK
*
Address for correspondence: Mr V Sankar, Ward 45, Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland, UK Fax: +44 (0)1224 554 569 E-mail: sankar747@hotmail.com

Abstract

Objectives:

To present the case of a ‘lost’ nasogastric tube and to highlight the importance of imaging and/or chest X-ray after nasogastric tube insertion, especially in unreliable patients.

Case report:

A 50-year-old man, undergoing radiotherapy treatment for squamous cell carcinoma of the tongue base, was admitted for pain control and nasogastric tube feeding. This patient required multiple nasogastric tubes over a two-week period. The patient repeatedly denied pulling the nasogastric tube out and we were unable to establish the exact mode of nasogastric tube removal. On one such occasion another tube was inserted and a check X-ray showed two feeding tubes; the latest one was lying in the left main bronchus and the old nasogastric tube was observed in the oesophagus, with its upper end jutting above the hypopharynx. It was apparent that the patient had somehow cut the tube and swallowed it.

Conclusion:

This case not only illustrates the importance of flexible nasendoscopy and/or chest X-ray for checking the position of the nasogastric tube, but also highlights that some patients are not tolerant of nasogastric tubes. The use of nasogastric tubes should be avoided in these patients to prevent any self-inflicted injury.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at the annual meeting of ENT UK, 11 September 2009, London, UK.

References

1Gopalan, S, Khanna, S. Enteral nutrition delivery technique. Curr Opin Clin Nutr Metab Care 2003;6:313–17CrossRefGoogle ScholarPubMed
2Sobol, SM, Conoyer, JM, Sessions, DG. Enteral and parenteral nutrition in patients with head and neck cancer. Ann Otol Rhinol Laryngol 1979;88:495501CrossRefGoogle ScholarPubMed
3Lin, CH, Liu, NJ, Lee, CS, Tang, JH, Wei, KL, Yang, C et al. Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest Endosc 2006;64:104–7CrossRefGoogle ScholarPubMed
4Wang, PC, Tseng, GY, Yang, HB, Chou, KC, Chen, CH. Inadvertent tracheobronchial placement of feeding tube in a mechanically ventilated patient. J Chin Med Assoc 2008;71:365–7CrossRefGoogle Scholar
5Metheny, NA. Risk factors for aspiration. JPEN J Parenter Enteral Nutr 2002;26(suppl 6):2631, S32–3CrossRefGoogle ScholarPubMed
6Chang, JL, Melnick, B, Bedger, RC, Bleyaert, AL. Inadvertent endobronchial intubation with nasogastric tube. Occurrence after head and neck surgery. Arch Otolaryngol 1982;108:528–9CrossRefGoogle ScholarPubMed
7Fisman, DN, Ward, ME. Intrapleural placement of a nasogastric tube: an unusual complication of nasotracheal intubation. Can J Anaesth 1996;43:1252–6CrossRefGoogle ScholarPubMed
8Baskin, WN. Acute complications associated with bedside placement of feeding tubes. Nutr Clin Pract 2006;21:4055CrossRefGoogle ScholarPubMed
9Metheny, NA, Meert, KL, Clouse, RE. Complications related to feeding tube placement. Curr Opin Gastroenterol 2007;23:178–82CrossRefGoogle ScholarPubMed
10Freij, RM, Mullett, ST. Inadvertent intracranial insertion of a nasogastric tube in a non-trauma patient. J Accid Emerg Med 1997;14:45–7CrossRefGoogle Scholar
11Galloway, DC, Grudis, J. Inadvertent intracranial placement of a nasogastric tube through a basal skull fracture. South Med J 1979;72:240–1CrossRefGoogle ScholarPubMed
12Ciocon, JO. Indications for tube feedings in elderly patients. Dysphagia 1990;5:15CrossRefGoogle ScholarPubMed
13Eldar, S, Meguid, MM. Pneumothorax following attempted nasogastric intubation for nutritional support. JPEN J Parenter Enteral Nutr 1984;8:450–2CrossRefGoogle ScholarPubMed
14Kolbitsch, C, Pomaroli, A, Lorenz, I, Gassner, M, Luger, TJ. Pneumothorax following nasogastric feeding tube insertion in a tracheostomized patient after bilateral lung transplantation. Intensive Care Med 1997;23:440–2CrossRefGoogle Scholar
15Gomes, GF, Pisani, JC, Macedo, ED, Campos, AC. The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia. Curr Opin Clin Nutr Metab Care 2003;6:327–33CrossRefGoogle ScholarPubMed
16Scolapio, JS. Methods for decreasing risk of aspiration pneumonia in critically ill patients. JPEN J Parenter Enteral Nutr 2002;26(suppl 6):5861, S61CrossRefGoogle ScholarPubMed
17Wu, PY, Kang, TJ, Hui, CK, Hung, MH, Sun, WZ, Chan, WH. Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis. J Formos Med Assoc 2006;105:80–5CrossRefGoogle Scholar
18Dinsmore, RC, Benson, JF. Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx. South Med J 1999;92:1005–7CrossRefGoogle ScholarPubMed
19May, S. Testing nasogastric tube positioning in the critically ill: exploring the evidence. Br J Nurs 2007;16:414–18CrossRefGoogle ScholarPubMed
20Karagama, YG, Lancaster, JL, Karkanevatos, A. Nasogastric tube insertion using flexible fibreoptic nasoendoscope. Hosp Med 2001;62:336–7CrossRefGoogle ScholarPubMed
21Takwoingi, YM, Demspter, JH. A simple technique for nasogastric feeding tube insertion. Eur Arch Otorhinolaryngol 2005;262:423–5CrossRefGoogle ScholarPubMed