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Authors: Savoulidou S. RN, Aslanidis Th. MD,PhD
Intensive Care Unit,St. Paul General Hospital, Thessaloniki,Greece
Abstract
Nasogastric tube is commonly used for administration of nutrition or medication in hospital wards and Intensive Care Units. However, its use is not without complications.In the present paper, a case report of nasogastric tube breakage is presented.
INTRODUCTION
The use of nasogastric tubes is omnipresent, and clinicians often take their insertion, function and maintenance for granted. However, their use does not come without complications: sinusitis, sore throat and epistaxis. Luminal perforation, pulmonary injury, aspiration, and intracranial placement are some of them found in the literature1-2. In the present article, we present a case report of a fractured nasogastric tube in an Intensive Care Unit patient.
Case report
A 63 year old male with history of Hydrocephalus was admitted intubated in the Intensive Care Unit for Status epilepticus. In his 45th day of hospitalisation , a programmed change of common nasogastric tube (NG) (single lumen Levin catheter) was performed. At the time, the patient was breathing via tracheostomy and was lightly sedated (Richmond Agitation Sedation scale: -1). An 18Fr catheter, was chosen.The tube was kept in the refrigerator in order to stiffening its natural curve. After lubrication of the end of a tube (local anaesthetic, such as 2% xylocaine gel),blind insertion was attempted via left nostril without problems.Position confirmation was assured via ascultation (syringe test) and aspiration of gastric content ; and the catheter was secured with tape. Yet, ten minutes later, during drug administration, a leak was noted just before the opening of the nostril (Figure 1). The leak was further confirmed with liquid administration and the NG tube was changed without any problems.
Figure 1. Two snapshots of the nasogastric tube, just point are also displayed.
Discussion
Several techniques have been described for NG tube insertion. Blind insertion remains the most common, yet under fluoroscopic, endoscopic, electromagnetic or direct surgical guidance is also used2. The use of frozen NG tube or similar techniques is often chosen in order to increase insertion success rate to intubated patients3-5; as the latter patient category poses extra challenges1.
Earlier literature reviews report that breaking of nasogastric tubes can happen to 11-20% of cases6. The latter can be caused either due to manufacturing defects or excessive feeding or drug administration impactions. In case of intracorporeal fractured tube fragments, these can be either removed endoscopically, or -if small enough- allowed to pass through gastrointestinal tract. We hypothesise that excessive freezing may the reason for NG tube breakage in our patient and that the direction of the breakage prevented leakage of gastric content during aspiration.
In any case high level of suspicion and frequent monitoring facilitates prevention and management of such mechanical complications.
References
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- Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014 Jul 14;20(26):8505-24.
- Chun DH, Kim NY, Shin YS, et al. A randomized, clinical trial of frozen versus standard nasogastric tube placement. World J Surg. 2009; 33:1789–92.
- Ghatak T, Samanta S, Baronia AK. A new technique to insert nasogastric tube in an unconscious intubated patient. N Am J Med Sci. 2013; 5:68–70.
- Raut MS. Use the natural curve of the nasogastric tube: A simple technique of insertion. Saudi J Anaesth. 2017 Oct-Dec;11(4):518-519.
- Cappell MS, Scarpa PJ, Nadler S, et al. Complications of nasoenteral tubes. Intragastric tube knotting and intragastric tube breakage. J Clin Gastroenterol 1992;14(2):144–14.
Author Disclosures: Authors have Savoulidou S., Aslanidis Th. have no conflicts of interest or financial ties to disclose.
Corresponding author:
Sophia Savoulidou RN,
58 Iroon Polytechniou,
PC 56224 Thessaloniki, Greece.
tel: +306974993274,
email:
