Pneumothorax secondary to nasogastric tube insertion – Case series report and literature review
EAES Academy. Salama M. 07/05/22; 363101; P146
Mr. Mohamed Salama
Contributions
Contributions
Abstract
Introduction:
Nasogastric tube (NGT) feeding has been around since it was first reported by John Hunter in 1769. Nowadays, it is extensively used worldwide, particularly for critically ill patients. Though it seems a simple procedure, it may carry potential life-threatening complications due to misplacement.
Many practitioners may not have considered the real potential fatal complications. We report our case series to raise awareness of NGT potential complications and recommend some critical points to minimise these preventable complications.
Case 1: A 73 year old lady, admitted with COVID 19, type I respiratory failure. She has a background history of DM type 2, IHD, CCF, CVA, DVTx3, CKD 3b, hypothyroidism, hypertension, ?Renal Cell Carcinoma. She had tracheostomy placed and fine bore NGT was inserted, and complicated with right-sided pneumothorax. Chest drain was inserted subsequently and lung became fully expanded. The drain was removed after patient’s full recovery.
Case 2: An 89 year old lady, admitted with community acquired pneumonia, bilateral consolidation and pleural effusion. She had a fine bore NGT inserted, and complicated with right sided pneumothorax therefore a chest drain was inserted. Unfortunately patient passed away after few days.
Case 3: An 84 year old lady, admitted with septic shock, asthma exacerbation and hypoxia. Fine bore NGT was inserted, and complicated with right-sided pneumothorax therefore a chest drain was inserted. Unfortunately, patient passed away few days later.
Conclusions:
Traditionally NGTs have been inserted blindly. Bedside confirmatory signs may not be reliable. Check x-ray detects the complication but does not prevent it. Pneumothorax is the most common complication of NG insertion. The 2-step insertion is an ideal way to prevent complications. Insertion of excess tubing is to be avoided. Tracheal entry can be detected using small disposable capnometers. Nasal endoscopes with guide-wire exchange are ideal for high-risk patients. Experienced operator, pre-NGT insertion risk assessment, proper technique of placement and post insertion confirmation are fundamental recommendations for safe NGT insertion
Nasogastric tube (NGT) feeding has been around since it was first reported by John Hunter in 1769. Nowadays, it is extensively used worldwide, particularly for critically ill patients. Though it seems a simple procedure, it may carry potential life-threatening complications due to misplacement.
Many practitioners may not have considered the real potential fatal complications. We report our case series to raise awareness of NGT potential complications and recommend some critical points to minimise these preventable complications.
Case 1: A 73 year old lady, admitted with COVID 19, type I respiratory failure. She has a background history of DM type 2, IHD, CCF, CVA, DVTx3, CKD 3b, hypothyroidism, hypertension, ?Renal Cell Carcinoma. She had tracheostomy placed and fine bore NGT was inserted, and complicated with right-sided pneumothorax. Chest drain was inserted subsequently and lung became fully expanded. The drain was removed after patient’s full recovery.
Case 2: An 89 year old lady, admitted with community acquired pneumonia, bilateral consolidation and pleural effusion. She had a fine bore NGT inserted, and complicated with right sided pneumothorax therefore a chest drain was inserted. Unfortunately patient passed away after few days.
Case 3: An 84 year old lady, admitted with septic shock, asthma exacerbation and hypoxia. Fine bore NGT was inserted, and complicated with right-sided pneumothorax therefore a chest drain was inserted. Unfortunately, patient passed away few days later.
Conclusions:
Traditionally NGTs have been inserted blindly. Bedside confirmatory signs may not be reliable. Check x-ray detects the complication but does not prevent it. Pneumothorax is the most common complication of NG insertion. The 2-step insertion is an ideal way to prevent complications. Insertion of excess tubing is to be avoided. Tracheal entry can be detected using small disposable capnometers. Nasal endoscopes with guide-wire exchange are ideal for high-risk patients. Experienced operator, pre-NGT insertion risk assessment, proper technique of placement and post insertion confirmation are fundamental recommendations for safe NGT insertion
Introduction:
Nasogastric tube (NGT) feeding has been around since it was first reported by John Hunter in 1769. Nowadays, it is extensively used worldwide, particularly for critically ill patients. Though it seems a simple procedure, it may carry potential life-threatening complications due to misplacement.
Many practitioners may not have considered the real potential fatal complications. We report our case series to raise awareness of NGT potential complications and recommend some critical points to minimise these preventable complications.
Case 1: A 73 year old lady, admitted with COVID 19, type I respiratory failure. She has a background history of DM type 2, IHD, CCF, CVA, DVTx3, CKD 3b, hypothyroidism, hypertension, ?Renal Cell Carcinoma. She had tracheostomy placed and fine bore NGT was inserted, and complicated with right-sided pneumothorax. Chest drain was inserted subsequently and lung became fully expanded. The drain was removed after patient’s full recovery.
Case 2: An 89 year old lady, admitted with community acquired pneumonia, bilateral consolidation and pleural effusion. She had a fine bore NGT inserted, and complicated with right sided pneumothorax therefore a chest drain was inserted. Unfortunately patient passed away after few days.
Case 3: An 84 year old lady, admitted with septic shock, asthma exacerbation and hypoxia. Fine bore NGT was inserted, and complicated with right-sided pneumothorax therefore a chest drain was inserted. Unfortunately, patient passed away few days later.
Conclusions:
Traditionally NGTs have been inserted blindly. Bedside confirmatory signs may not be reliable. Check x-ray detects the complication but does not prevent it. Pneumothorax is the most common complication of NG insertion. The 2-step insertion is an ideal way to prevent complications. Insertion of excess tubing is to be avoided. Tracheal entry can be detected using small disposable capnometers. Nasal endoscopes with guide-wire exchange are ideal for high-risk patients. Experienced operator, pre-NGT insertion risk assessment, proper technique of placement and post insertion confirmation are fundamental recommendations for safe NGT insertion
Nasogastric tube (NGT) feeding has been around since it was first reported by John Hunter in 1769. Nowadays, it is extensively used worldwide, particularly for critically ill patients. Though it seems a simple procedure, it may carry potential life-threatening complications due to misplacement.
Many practitioners may not have considered the real potential fatal complications. We report our case series to raise awareness of NGT potential complications and recommend some critical points to minimise these preventable complications.
Case 1: A 73 year old lady, admitted with COVID 19, type I respiratory failure. She has a background history of DM type 2, IHD, CCF, CVA, DVTx3, CKD 3b, hypothyroidism, hypertension, ?Renal Cell Carcinoma. She had tracheostomy placed and fine bore NGT was inserted, and complicated with right-sided pneumothorax. Chest drain was inserted subsequently and lung became fully expanded. The drain was removed after patient’s full recovery.
Case 2: An 89 year old lady, admitted with community acquired pneumonia, bilateral consolidation and pleural effusion. She had a fine bore NGT inserted, and complicated with right sided pneumothorax therefore a chest drain was inserted. Unfortunately patient passed away after few days.
Case 3: An 84 year old lady, admitted with septic shock, asthma exacerbation and hypoxia. Fine bore NGT was inserted, and complicated with right-sided pneumothorax therefore a chest drain was inserted. Unfortunately, patient passed away few days later.
Conclusions:
Traditionally NGTs have been inserted blindly. Bedside confirmatory signs may not be reliable. Check x-ray detects the complication but does not prevent it. Pneumothorax is the most common complication of NG insertion. The 2-step insertion is an ideal way to prevent complications. Insertion of excess tubing is to be avoided. Tracheal entry can be detected using small disposable capnometers. Nasal endoscopes with guide-wire exchange are ideal for high-risk patients. Experienced operator, pre-NGT insertion risk assessment, proper technique of placement and post insertion confirmation are fundamental recommendations for safe NGT insertion
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