Accidental Intravascular Placement of a Feeding Tube

Duthorn, Ludwig; Steinberg, Hans Schulte; Häuser, H.; Neeser, G.; Pracki, Pavel

doi:10.1097/00000542-199807000-00031

Cited by 26 publications

(14 citation statements)

References 10 publications

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“…14 Although nasopulmonary intubation is the most common site of misplacement, there have been reports of peritoneal, mediastinal, intravascular, and intracranial misplacement. [15][16][17][18][19] Each of these incidents has the potential to be a lethal event and can be avoided with the reduction in tube replacement provided by routine bridling.…”

Section: Discussionmentioning

confidence: 99%

The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

Seder

Janczyk

2008

Nut in Clin Prac

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Section: Discussionmentioning

confidence: 99%

The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

Seder

Janczyk

2008

Nut in Clin Prac

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“…sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients (1–3). Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible (1, 4–7); even intravascular (8, 9) and intracranial misplacement have been reported (10–13). The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed.…”

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confidence: 99%

Malpositioning of fine bore feeding tube: A serious complication

Kawati

Rubertsson

2005

Acta Anaesthesiol Scand

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Feeding tubes are used frequently in the intensive care unit to provide enteral nutrition. For critically ill patients, enteral nutrition is preferable to parenteral in terms of cost, complication and gut mucosal maintenance. Fine bore feeding tubes are always preferred because their soft, flexible construction and narrow diameter enables these tubes to be well tolerated by patients and they rarely contribute to sinus infections or obstruction of breathing. On the other hand it is not uncommon that these tubes are misplaced in the tracheobronchial tree or the pleural cavity, especially in high-risk patients, i.e. sedated patients, patients with weak cough reflex, endotracheally intubated patients and agitated patients. Malpositioning in the peritoneal cavity or the mediastinum through gastric or esophageal perforation is also possible; even intravascular and intracranial misplacement have been reported. The incidence of misplacement of a feeding tube is difficult to estimate because few studies have been performed. The largest study of 1100 such tubes revealed an overall malposition rate of 1.3%, but it should be mentioned that this study included only radiographically detected misplacements. Other researchers estimate the occurrence of accidental misplacement and migration out of position as high as 13% to 20% in high-risk patients.

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“…To our knowledge, Duthorn et al . [10] reported the only other known case of NGT placement into the internal jugular vein. Multiple imaging modalities including plane chest radiographs were used to identify placement in this case.…”

Section: Discussionmentioning

confidence: 99%

A case of fatal internal jugular vein perforation during nasogastric tube insertion

Smith

Fleming

Bennett

et al. 2017

Journal of Surgical Case Reports

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Nasogastric tube (NGT) insertion is a routine procedure in the management of surgical patients. We report the second case of internal jugular vein perforation during NGT insertion. A 79-year-old man presented with diffuse abdominal pain secondary to a perforated viscus. Abdominal CT revealed pneumoperitoneum, necessitating emergent exploratory laparotomy. On post-operative Day 7, the patient developed mild abdominal distension and subjective nausea for which NGT placement was ordered for decompression. Tube placement was confirmed by insufflation of air without aspiration of gastric contents. Output from the NGT upon placement revealed frank blood. The patient then developed respiratory distress requiring intubation, followed by a fatal arrhythmia. Post-mortem exam revealed the trajectory of the NGT through the pharyngeal wall into the right internal jugular vein. This case illustrates the importance of systematic evaluation of all procedures, as the outcome resulted from failure to recognize the initial error in tube placement.

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Accidental Intravascular Placement of a Feeding Tube

Cited by 26 publications

References 10 publications

The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

The Routine Bridling of Nasojejunal Tubes Is a Safe and Effective Method of Reducing Dislodgement in the Intensive Care Unit

Malpositioning of fine bore feeding tube: A serious complication

A case of fatal internal jugular vein perforation during nasogastric tube insertion

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