Critical Care and Shock

Case report and review – Nasogastric tube complications

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The placement of nasogastric (NG) tubes is an extremely common intervention in general surgical wards and intensive care units. We report a case series of two patients who developed life threatening complications from the insertion of nasogastric tubes. Case 1 was a 71 year old man admitted to the Intensive Care Unit with pancreatitis who had three isolated complications from NG tube insertion. Firstly he developed a severe aspiration pneumonitis requiring intubation and ventilation; secondly on reinserting a NG tube he developed a narrow complex tachycardia with cardiovascular compromise requiring electrical cardioversion; and thirdly he developed a large pneumothorax following inadvertent insertion of a fine bore feeding tube into his left pleural space. Case 2 was an 83 year old woman with a large sacral pressure sore who was admitted to a surgical ward for enteral feeding. She also developed a pneumothorax following pleural insertion of a fine bore feeding tube.

This case series serves as a reminder to the rare but potentially serious complications associated with NG tube insertion. Following our experience and of review of the literature we want to stress the importance of avoiding NG tubes in facial trauma; correctly positioning the patient prior to insertion; being aware of the limitation of beside tests in establishing the position of the NG tube; using x-ray to confirm tube placement and monitoring patients closely following the removal of a misplaced tube.

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