Nasogastric Tube Knotting Over the Epiglottis: A Cause of Respiratory Distress

Abstract

Nasogastric tube placement can cause ulceration and bleeding from the nose, pharynx, esophagus, and stomach. Its accidental placement into the tracheopulmonary system may lead to pneumothorax, hemothorax, or even death. We report a case of its knotting over the epiglottis, leading to life-threatening respiratory distress.

Removal of self-knotted nasogastric tube Technical Note

“…Although numerous complications of gastric tube insertion have been reported [1][2][3]5,9,10 , including knotting around endotracheal tubes 2 , NGT coiling or knotting is an uncommon occurrence, and is more commonly seen with small-diameter tubes 3,5 . This case report serves as a reminder that this can occur with large-bore feeding tubes as well.…”

Knotted nasogastric tube in the posterior nasopharynx: A case report

“…1 Complications of nasogastric tube insertion and removal have been reported with a mortality rate of 0.3% 4 and among the causes, the rare occurrence of knotting has been previously reported. 1,2,5 Different techniques to remove such knotted nasogastric tubes depending on the location of the knot have been reported, for example by cutting and removing the knotted part through the mouth; 2,6 passing a larger nasogastric tube over the knotted tube and removing them together; 3 or removing the knotted nasogastric tube under fibroscopy.…”

A Forgotten Nasogastric Tube

“…The knotted NGT may even cause respiratory distress. 10 Methods of removal of knotted or twisted NGT's include: Through the mouth, using an endoscope or even a nasopharyngeal airway. 7,11,12 The use of nasopharyngeal airway prevents the knot becoming stuck within the nasal cavity or in the nasopharynx.…”