Malposition of a nasogastric feeding tube into the right pleural space of a poststroke patient

Abstract Background: Nasogastric feeding tube plays an important role in nutrition intake, drug administration, and stomach emptying for patients with severe dysphagia. However, inserting nasogastric tubes is not absolutely harmless. Inadvertent malposition into the trachea or the pleural cavity could result in severe pulmonary complications. Case presentation: We present a case of a 67-year-old patient with a history of nasopharyngeal carcinoma and after the treatment of radiotherapy and chemotherapy. Nasogastric tubes have to be placed for enteral nutrition and avoiding aspiration owing to his severe dysphagia. Unfortunately, he experienced a malposition of nasogastric tube into the right pleura cavity after blind replacement by nurse, whereas the nurses and physicians did not recognize this fault, even the bedside chest radiography (X-ray) was performed twice after intubation. A week later, his condition deteriorated so rapidly that he had to undergo tracheotomy, and the tube was finally found in his trachea.Conclusions: The Nasopharyngeal carcinoma patients after radiotherapy and chemotherapy should be fully evaluated before the nasogastric tube placement whether the blind insertion is suitable or not. Meanwhile, we should not feed immediately unless we have a radiograph to verify the right position of NG tube. Furthermore, careful monitoring of both typical and untypical symptoms of malposition is essential during tube feeding.

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Long-Term Nasogastric Feeding Tube

JAMA ◽

10.1001/jama.1969.03160290109037 ◽

1969 ◽

Vol 210 (3) ◽

pp. 557

Author(s):

Lee R. Sataline

Keyword(s):

Feeding Tube ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube

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Bacterial contamination of nasogastric feeding tube and development of neonatal sepsis in premature newborns: a prospective observational research at a tertiary care center in Gujarat, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182547 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1462

Author(s):

Rekha Thaddanee ◽

Shamim Morbiwala ◽

Hasmukh Chauhan ◽

Jigar Gusani ◽

Parima Dalal

Keyword(s):

Necrotizing Enterocolitis ◽

Neonatal Sepsis ◽

Microbial Growth ◽

Tertiary Care ◽

Feeding Tube ◽

Feeding Intolerance ◽

Nasogastric Feeding ◽

Premature Newborns ◽

Nasogastric Feeding Tube ◽

Group I

Background: The objective of the present study is to observe the effect of frequency of changing nasogastric feeding tube (NG-FT) on microbial growth in relation to development of neonatal sepsis in premature newborns. The study is prospective observational study in its nature. Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to November 2017.Methods: Eighty-five preterm newborns admitted to NICU for feeding support were randomly divided into three groups depending on frequency of changing nasogastric feeding tubes (Group I, II and III with NG-FT changed every 12, 24 and 48 hourly respectively). In Groups I, II and III, the first NG-FT cultures were sent at the end of 12, 24, 48 hours of NG-FT insertion respectively. The second and third NG-FT cultures were sent after 7 and 14 days respectively. Microbial growth pattern was observed and correlated with development of necrotizing enterocolitis (NEC), neonatal sepsis and mortality.Results: Microbial growth on first NG-FT culture significantly increased when frequency of changing nasogastric feeding tube was reduced from every 12 to 24 or 48 hours {p = 0.0432 (Group I vs II) and 0.0001 (Group I vs III)}. Microbial growth increased on second (24.1%, 87% and 85% in groups I, II and III respectively) and third NG-FT culture (44% in group I and 100% in groups II and III); this was significantly high in group II and III as compared to group I (p = 0.0001). Common organisms isolated were Klebsiella pneumonia (63.28%), Pseudomonas aeruginosa (32%) and Escherichia coli (21%). No significant difference was noted in incidences of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality among the three groups.Conclusions: Organism growth in nasogastric feeding tube culture increases significantly when frequency of changing NG-FT is beyond 12 hours. However, there is no increase in episodes of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality.

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Nutrothorax complicating a misplaced nasogastric feeding tube in a severely ill patient

Autopsy and Case Reports ◽

10.4322/acr.2012.003 ◽

2012 ◽

Vol 2 (1) ◽

pp. 19-24

Author(s):

Aloísio Felipe-Silva ◽

Fernando Peixoto Ferraz de Campos

Keyword(s):

Feeding Tube ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube

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Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Frontiers in Neurology ◽

10.3389/fneur.2021.605687 ◽

2021 ◽

Vol 12 ◽

Author(s):

Li Zeng ◽

Yu Song ◽

Yan Dong ◽

Qian Wu ◽

Lu Zhang ◽

...

Keyword(s):

Tracheal Intubation ◽

Characteristic Curve ◽

Feeding Tube ◽

Apache Ii ◽

Selection Strategy ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube ◽

Multicenter Prospective Observational Study ◽

Validation Set ◽

Risk Predictors

Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.

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