Radiographic Confirmation of Feeding Tube Placement: A Diagnostic Tool Identifying Gastrointestinal Anomalies

Soylu, Hanifi; Wiseman, Nathan E.; El‐Sayed, Yasser Y.; Man, Yi; Baier, Reinhard

doi:10.1891/0730-0832.32.2.89

Cited by 8 publications

(3 citation statements)

References 15 publications

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“…This echoes the literature where routine post-tube insertion Xray [5,7], and acute deterioration in respiratory status [6,10,17,18] led to the diagnosis of NEP. X-ray may show an abnormal path of the enterogastric tube [7,19], or pneumothorax/pneumomediastinum with or without pleural effusion [1,5,6,10]. The diagnosis may also be considered if the gastric aspirates are blood-stained immediately after tube insertion [20].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Sorensen

Chuang

et al. 2023

Children

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Background: The aim of this multicenter retrospective study and literature review was to review management and outcomes of neonatal esophageal perforation (NEP). Methods: Protocol data were collected from four European Centers on gestational age, factors surrounding feeding tube insertion, management and outcomes. Results: The 5-year study period (2014–2018) identified eight neonates with median gestational age of 26 + 4 weeks (23 + 4–39) and median birth weight 636 g (511–3500). All patients had NEP from enterogastric tube insertions, with the perforation occurring at median 1st day of life (range 0–25). Seven/eight patients were ventilated (two/seven-high frequency oscillation). NEP became apparent on first tube placement (n = 1), first change (n = 5), and after multiple changes (n = 2). Site of perforation was known in six (distal n = 3, proximal n = 2 and middle n = 1). Diagnosis was established by respiratory distress (n = 4), respiratory distress and sepsis (n = 2) and post-insertion chest X-ray (n = 2). Management in all patients included antibiotics and parenteral nutrition with two/eight receiving steroids and ranitidine, one/eight steroids only and one/eight ranitidine only. One neonate had a gastrostomy inserted, while in another an enterogastric tube was orally successfully re-inserted. Two neonates developed pleural effusion and/or mediastinal abscess requiring chest tube. Three neonates had significant morbidities (related to prematurity) and there was one death 10 days post-perforation (related to prematurity complications). Conclusions: NEP during NGT insertion is rare even in premature infants after evaluating data from four tertiary centers and reviewing the literature. In this small cohort, conservative management seems to be safe. A larger sample size will be necessary to answer questions on efficacy of antibiotics, antacids and NGT re-insertion time frame in NEP.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Sorensen

Chuang

et al. 2023

Children

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“…Besides, 40 ml warm water was fed through NG tube, and the patient had no adverse reactions such as choking, signs of respiratory distress, etc. Nevertheless, the bedside radiography was not carried out immediately because of its de ciency, such as delayed enteral feeding administration and the risk of radiation exposure to patients [24][25][26]. Unfortunately, this patient encountered malposition of the NG tube.…”

Section: Discussionmentioning

confidence: 99%

Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

Zhang

Zhu

Liu

et al. 2021

Preprint

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Background: Nasogastric feeding tube plays an important role in nutrition intake, drug administration, and stomach emptying for patients with severe dysphagia. However, inserting nasogastric tubes is not absolutely harmless. Inadvertent malposition into the trachea or the pleural cavity could result in severe pulmonary complications. Case presentation: We present a case of a 67-year-old patient with a history of nasopharyngeal carcinoma and after the treatment of radiotherapy and chemotherapy. Nasogastric tubes have to be placed for enteral nutrition and avoiding aspiration owing to his severe dysphagia. Unfortunately, he experienced a malposition of nasogastric tube into the right pleura cavity after blind replacement by nurse, whereas the nurses and physicians did not recognize this fault, even the bedside chest radiography (X-ray) was performed twice after intubation. A week later, his condition deteriorated so rapidly that he had to undergo tracheotomy, and the tube was finally found in his trachea.Conclusions: The Nasopharyngeal carcinoma patients after radiotherapy and chemotherapy should be fully evaluated before the nasogastric tube placement whether the blind insertion is suitable or not. Meanwhile, we should not feed immediately unless we have a radiograph to verify the right position of NG tube. Furthermore, careful monitoring of both typical and untypical symptoms of malposition is essential during tube feeding.

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“… 13–17 However, it is associated with high costs, delayed enteral feeding administration and the exposure of the patient to radiation. 18 19 In addition, the costs related to radiographic examinations are significant. While a typical pH test strip costs less than 25 cents, a single chest or abdominal radiography may cost from $100 to several hundred US dollars.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study

et al. 2020

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IntroductionPatients using a nasogastric tube (NGT) are vulnerable to adverse events, therefore proper assessment of these patients, verification of the correct tube placement and constant monitoring by the nursing staff are strategies that can reduce adverse events and risks associated with the care. The aim of this study will be to assess the accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement compared with the X-ray method. A further aim will be to measure and provide evidence for the direct costs of each method of confirming NGT placement and to evaluate the impact of each method on the mean direct cost of the patient.Methods and analysisThis is a prospective, single-centre study of diagnostic accuracy. Data will be collected in the clinical and surgical wards, intensive care unit and coronary care unit of a Brazilian teaching hospital. The sample will consist of 385 assessments, performed in adult patients that agree to participate in the study and that receive an NGT. The combined method and the ultrasound will be the index tests and will be performed on all study participants for later comparison with an X-ray examination, considered the reference standard and the gold standard to distinguish between gastric and pulmonary placement. Sensitivity, specificity, positive predictive value and negative predictive value will be calculated to assess the diagnostic accuracy of the methods investigated in this study, with Cohen’s kappa analysis used to evaluate the degree of concordance.Ethics and disseminationThe study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, registration number: 83087318.4.0000.5393. The findings will be reported through academic journals, seminars and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.

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Radiographic Confirmation of Feeding Tube Placement: A Diagnostic Tool Identifying Gastrointestinal Anomalies

Cited by 8 publications

References 15 publications

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Iatrogenic Neonatal Esophageal Perforation: A European Multicentre Review on Management and Outcomes

Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study

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