Complications of Nasogastric Tube Insertion

Abstract

To the Editor:Iatrogenic complications in medicine are increasing, especially in critical care management due to the aggressive measures and invasive procedures that are performed. Insertion of nasogastric tubes for gastric suction and/or feeding, and endotracheal intubation are almost routine procedures in an ICU or critical care setting. Many complications of nasogastric tube insertion have already been published or mentioned in the literature. A computer search of all published complications made no mention of a recently-observed complication that happened to one of our patients. Reviewed literature mentioned the following as complications: 1) aspiration pneumonia, 2) fatal hematemesis due to erosion of retroesophageal right subclavian artery, 3) esophago-aortic fistula and congenital anomaly of the thoracic aorta, 4) intracranial placement of nasogastric tube in a patient with severe head trauma and on another patient with pituitary tumor, 6) fatal hydrothorax and empyema.1Torrington KG Bowman M. Fatal hydrothorax and empyema complicating a malpositioned nasogastric tube.Chest. 1987; 79: 240-242Abstract Full Text Full Text PDF Scopus (64) Google ScholarOur recent experience involved an elderly comatose black man who was intubated due to respiratory failure. Nasogastric tube was inserted by an experienced ICU nurse but for some reason she had difficulty passing through the oropharyngeal area. She continued the insertion and the tip of the nasogastric tube came out of the mouth. Evidently it has coiled in the oropharynx. Upon attempts to withdraw the nasogastric tube, she had difficulty pulling it back either from the proximal or distal end of the tube. The more she pulled, the tighter it got. The patient started having breathing difficulty while she continued attempting to remove the tube. It became apparent that the nasogastric tube, as it coiled in the oropharynx, made a loop around the nasogastric tube and became tight as she tried to pull it out. This constricted the endotracheal tube to a point of strangulation. Fortunately, the problem was identified and the problem was corrected by using a laryngoscope and scissor to cut then nasogastric tube from around the nasotracheal tube.This may be a rare occurrence but it must be remembered that if there is difficulty at any time during insertion of a nasogastric tube it should not be forced and, if there is coexisting endotracheal tube, the potential of entanglement should be considered if difficulty in insertion or pulling the tube is encountered. To the Editor: Iatrogenic complications in medicine are increasing, especially in critical care management due to the aggressive measures and invasive procedures that are performed. Insertion of nasogastric tubes for gastric suction and/or feeding, and endotracheal intubation are almost routine procedures in an ICU or critical care setting. Many complications of nasogastric tube insertion have already been published or mentioned in the literature. A computer search of all published complications made no mention of a recently-observed complication that happened to one of our patients. Reviewed literature mentioned the following as complications: 1) aspiration pneumonia, 2) fatal hematemesis due to erosion of retroesophageal right subclavian artery, 3) esophago-aortic fistula and congenital anomaly of the thoracic aorta, 4) intracranial placement of nasogastric tube in a patient with severe head trauma and on another patient with pituitary tumor, 6) fatal hydrothorax and empyema.1Torrington KG Bowman M. Fatal hydrothorax and empyema complicating a malpositioned nasogastric tube.Chest. 1987; 79: 240-242Abstract Full Text Full Text PDF Scopus (64) Google Scholar Our recent experience involved an elderly comatose black man who was intubated due to respiratory failure. Nasogastric tube was inserted by an experienced ICU nurse but for some reason she had difficulty passing through the oropharyngeal area. She continued the insertion and the tip of the nasogastric tube came out of the mouth. Evidently it has coiled in the oropharynx. Upon attempts to withdraw the nasogastric tube, she had difficulty pulling it back either from the proximal or distal end of the tube. The more she pulled, the tighter it got. The patient started having breathing difficulty while she continued attempting to remove the tube. It became apparent that the nasogastric tube, as it coiled in the oropharynx, made a loop around the nasogastric tube and became tight as she tried to pull it out. This constricted the endotracheal tube to a point of strangulation. Fortunately, the problem was identified and the problem was corrected by using a laryngoscope and scissor to cut then nasogastric tube from around the nasotracheal tube. This may be a rare occurrence but it must be remembered that if there is difficulty at any time during insertion of a nasogastric tube it should not be forced and, if there is coexisting endotracheal tube, the potential of entanglement should be considered if difficulty in insertion or pulling the tube is encountered.