Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

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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Immediate chest radiograph interpretation by radiographers improves patient safety related to nasogastric feeding tube placement in children

Pediatric Radiology ◽

10.1007/s00247-021-05032-9 ◽

2021 ◽

Author(s):

Emily Keyte ◽

Gillian Roe ◽

Annmarie Jeanes ◽

Jeannette K. Kraft

Keyword(s):

Patient Safety ◽

Nasogastric Tube ◽

Improve Patient Safety ◽

Feeding Tube ◽

Practice Change ◽

Tube Placement ◽

Nasogastric Feeding ◽

Nasogastric Tubes ◽

National Patient ◽

Nasogastric Tube Placement

Abstract Background Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results. Objective The objectives were to determine whether training in a new pathway introduced to avoid these “never events” was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children. Materials and methods Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0–16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes. Results We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95–0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes. Conclusion Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.

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Nasendoscopically-assisted placement of a nasogastric feeding tube

The Journal of Laryngology & Otology ◽

10.1017/s0022215100145347 ◽

1999 ◽

Vol 113 (9) ◽

pp. 839-840 ◽

Cited By ~ 9

Author(s):

Gerard Kelly ◽

Patrick Lee

Keyword(s):

Parenteral Nutrition ◽

Nasogastric Tube ◽

Feeding Tube ◽

Oral Feeding ◽

Tube Placement ◽

Nasogastric Feeding ◽

Nasogastric Tubes ◽

Term Administration ◽

Enteral Access ◽

Nasogastric Tube Placement

AbstractNasogastric tube placement is desirable for the short-term administration of calories when oral feeding is not possible. Enteral nutrition is superior to parenteral nutrition. In some patients this method of feeding is impossible because of repeated failure of nasogastric tube placement, necessitating either general anaesthesia for enteral access, or total parenteral nutrition. We describe a new method for nasogastric tube placement aided by a fibre-optic nasendoscope which has resulted in the successful placement of over 20 nasogastric tubes in our unit and the avoidance of more invasive methods of establishing nutrition with their associated complications.

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Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube

Case Reports in Pediatrics ◽

10.1155/2016/4103734 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2

Author(s):

Lukas P. Mileder ◽

Martin Müller ◽

Friedrich Reiterer ◽

Alexander Pilhatsch ◽

Barbara Gürtl-Lackner ◽

...

Keyword(s):

Nasogastric Tube ◽

Esophageal Perforation ◽

Signs And Symptoms ◽

Feeding Tube ◽

Tube Placement ◽

Nasogastric Feeding ◽

Medical Interventions ◽

Life Saving ◽

Diagnostic Approaches ◽

Nasogastric Tube Placement

Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

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