Chest
Clinical InvestigationsPleuropulmonary Complications of Enteral Tube Feedings: Two Reports, Review of the Literature, and Recommendations
Section snippets
Case 1
A 68-year-old woman with chronic obstructive pulmonary disease (COPD) was admitted to the Medical University Hospital for increasing shortness of breath. Pulmonary angiograms documented pulmonary thromboembolism, and therapy with heparin was initiated. The patient's medical history was complicated by chronic renal insufficiency, nephrotic syndrome of undefined etiology, a right mastectomy for breast cancer, and probable primary hyperparathyroidism. Worsening respiratory failure required
Discussion
When a foreign object is inserted into the body, it can cause injury from the site of entry to the site of distal placement. Since the introduction of nasogastric tubes, refinements have been made, and the spectrum of injuries has changed. Earlier large-bore stiff tubes (16 to 20 French) were inserted easily,10 but there were problems related to the patients comfort and to ischemia and necrosis of superficial tissues due to compression of the tube against mucosal surfaces. Ulceration and
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Pleural Effusion
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionA review of published case reports of inadvertent pulmonary placement of nasogastric tubes in children
2014, Journal of Pediatric NursingCitation Excerpt :A study found that 30 nurses had difficulty distinguishing between photographs of gastric fluid, pleural fluid, and tracheobronchial secretions (Metheny et al., 1994). There are reports in which aspirates from feeding tubes in the pleural space were perceived to be gastric fluid (Miller, Tomlinson, & Sahn, 1985; Nakao, Killam, & Wilson, 1983; Theodore, Frank, Ende, Snider, & Beer, 1984). Inadvertent pulmonary placement of nasogastric tubes can lead to serious and even lethal results in children.
Ultrasound evaluation of the nasogastric tube position in prehospital
2012, Annales Francaises d'Anesthesie et de ReanimationUltrasound to confirm gastric tube placement in prehospital management
2012, ResuscitationCitation Excerpt :Whilst the misplacement rate appears low (between 0.5 and 1.5%), the exact frequency is difficult to determine.1 The complications are exceptional may be very serious, such as perforation or misplacement in the tracheobronchial tree, possibly with pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumonia, pulmonary haemorrhage, empyema, haemothorax, bronchopleural fistula, mediastinitis, and perforation of the oesophagus, and even in rare cases, intravascular or intracranial misplacement.1–8 Moreover, for critically ill patients managed by an emergency physician in a prehospital setting, there are several major underlying factors favouring tube misplacement, including impaired gag reflex, recent endotracheal intubation, decreased laryngeal sensitivity and neuromuscular blocking drugs.1–4
A near miss; malpositioned nasogastric tube in the left bronchus of a spontaneously breathing critically-ill patient
2010, Current Anaesthesia and Critical CareCitation Excerpt :Clinical diagnosis encompasses being comfortable with the placement, by the aspiration of stomach contents and by auscultation for insufflated air. These methods which include visual inspection of aspirate, air insufflation and auscultation and observing the patient for signs and symptoms are useful when obvious but can be extremely misleading and are all unreliable.1,10 More sophisticated tests such as detection of bilirubin, trypsin, or pepsin not readily available at the bedside.
Using ultrasonography for verifying feeding tube placements in cats
2023, Frontiers in Veterinary Science
Manuscript received December 20; revision accepted January 30.