A simple procedure gone wrong: pneumothorax after inadvertent transbronchial nasogastric tube insertion necessitating operative management.

Abstract

Nasogastric tube insertion (NGT) is a common bedside procedure and malpositioned tubes into the tracheobronchial are not uncommon. These can be associated with pulmonary complications. Significantly, pneumothoraces are rare but potential complications that clinicians need to be aware of. We herein report a case of pneumothorax following NGT insertion that necessitated operative management. A 72-year-old male smoker was undergoing rehabilitation after a recent cerebrovascular accident. A NGT change was done and the chest radiograph done to check placement demonstrated the NGT in the right bronchus with the tip in the right pleural space. The NGT was removed and a new one reinserted. A repeat chest radiograph demonstrated a right sided pneumothorax. He underwent radiologically guided chest drain insertion and subsequently required thoracoscopic surgery where a wedge resection of the right lower lobe was performed. The chest drain was removed on day two post operatively and he made an uneventful recovery.

Eventos Adversos Relacionados À Sonda Enteral: Revisão Integrativa

“…Os dados sobre mau posicionamento de SE variam de 0,3 a 15% (40) . Entre os relatos mais frequentes no presente estudo, estão a inserção da SE em árvore brônquica e pulmão (34)(35)(36)(37)(38) e no cérebro (12,14,24,29) , enquanto a perfuração esofágica (26) , gástrica (11) , intestinal (25) e inserção da sonda em átrio (27) foram menos reportados.…”

Pneumothorax induced by the incorrect insertion of a nasogastric tube

“…She required thoracostomy by insertion of a drainage tube. Incorrect insertion of tubes into the tracheobronchial tree occurs in 0.3–15% of cases 1 . Pneumothorax has also been reported 1 .…”

“…Incorrect insertion of tubes into the tracheobronchial tree occurs in 0.3–15% of cases 1 . Pneumothorax has also been reported 1 . Two methods for confirming the position of the NGT are currently recommended: 2 chest X‐ray and a pH test.…”

“…If the pH of the aspirate is ≥6 or if no gastric aspirate is obtained, then a chest radiograph needs to be obtained to determine the NGT placement. Other methods, such as insufflation, can be inaccurate and should not be used 1,2 . In addition, the physician should be more careful when they feel resistance during gastric tube insertion.…”

Hemothorax Following Traumatic Dobhoff Tube Insertion

“…A large majority of these cases are met with no complications. However, there have been several reported instances of inadvertent bronchopulmonary placement that have resulted in significant pulmonary trauma, particularly pneumothorax [3][4][5][6][7][8]. Hemothorax (a collection of blood within the pleural cavity) has been mentioned as a potential complication of a misplaced enteral feeding tube, but very few cases have been documented previously [9,10].…”