Abstract
Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the position and promote safe placement of the feeding tubes. Recent findings: Malpositioned feeding tubes are not included in risk management databases. The reported incidence is 1-3% and more than half occur in mechanically ventilated patients. Eighty three mechanically ventilated patients were reported with malpositioned nasogastric tubes and 66% of them developed serious thoracic complications. Pneumothoraces accounted for 80% of thoracic complications that were evenly distributed between tubes with and without stylet. Repeated misplacements appear to increase the risk. Non-radiological confirmation of the position of the tube has suboptimal performance. Protocols to place feeding tubes and new technology are promising candidates. Summary: Malpositioned nasogastric feeding tubes are underreported and associated with serious thoracic complications in mechanically ventilated patients. We need more data to answer whether we can afford to prevent them.
Highlights
Ill patients, who cannot meet their daily nutriant requirements by oral intake but have a functional gastrointestinal tract should be considered for enteral feeding [1]
Sorokin et al reported an incidence of malpositioned tubes of 1.3% of which > 50% occurred in mechanically ventilated patients, with a procedure related rate of serious thoracic complications of
Endoscopy reported a gastric ulcer associated with a tubular foreign body which was proved to be the endotracheal tube that was used to facilitate the insertion of the nasogastric tube [35]
Summary
Ill patients, who cannot meet their daily nutriant requirements by oral intake but have a functional gastrointestinal tract should be considered for enteral feeding [1]. Usually considered a simple procedure the blind placement of nasogastric feeding tubes is not without risks. This is the reason why the National Patient Safety Agency in the United Kingdom has recently issued a safety alert regarding the placement of nasogastric feeding tubes in neonatal intensive care units [2]. The malpositioned nasogastric feeding tubes are not included in risk management databases, they may well be underreported This may ex-plain, at least in part why the data on malpositioned nasogastric tubes in mechanically ventilated patients are limited. This review outline the thoracic complications associated with the blind placement of the nasogastric feeding tube for mechanically ventilated patients in intensive care, and the methods used to verify the position and promote safer gastric placement of the nasogastric tubes
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