Blindly inserted nasogastric feeding tubes and thoracic complications in intensive care


Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the position and promote safe placement of the feeding tubes. Recent findings: Malpositioned feeding tubes are not included in risk management databases. The reported incidence is 1-3% and more than half occur in mechanically ventilated patients. Eighty three mechanically ventilated patients were reported with malpositioned nasogastric tubes and 66% of them developed serious thoracic complications. Pneumothoraces accounted for 80% of thoracic complications that were evenly distributed between tubes with and without stylet. Repeated misplacements appear to increase the risk. Non-radiological confirmation of the position of the tube has suboptimal performance. Protocols to place feeding tubes and new technology are promising candidates. Summary: Malpositioned nasogastric feeding tubes are underreported and associated with serious thoracic complications in mechanically ventilated patients. We need more data to answer whether we can afford to prevent them.

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Giantsou, E. and Gunning, K. (2010) Blindly inserted nasogastric feeding tubes and thoracic complications in intensive care. Health, 2, 1135-1141. doi: 10.4236/health.2010.210166.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] De Aguilar-Nascimento, J.E. and Kudzu, K.A. (2007) Clinical costs of feeding tube placement. Journal of Parenteral and Enteral Nutrition, 31(4), 269-273.
[2] National Patient Safety Agency, Reducing the harm caused by misplaced nasogastric and orogastric feeding tubes in babies under the care of neonatal units, 2005. http// Alert.pdf
[3] Sorokin, R. and Gottlieb, J. (2006) Enhancing patient safety during feeding tube insertion: A review of more than 2000 insertions. Journal of Parenteral and Enteral Nutrition, 30(5), 440-445.
[4] Rassias, A.J., Ball, P.A. and Corwin, H.L. (1998) A prospective study of tracheopulmonary complications associated with the placement of narrow bore enteral feeding tubes. Critical Care, 2(1), 25-28.
[5] Mardestein, E.I., Simmons, R.L. and Ochoa, J.B. (2004) Patient safety: Effect of institutional protocols on adverse events related to feeding tube placement in the critically ill. Journal of the American College of Surgeons, 199(1), 41-47.
[6] James, R.H. (1978) An unusual complication passing a narrow bore nasogastric tube. Anaesthesia, 33(8), 716- 718.
[7] Pillai, J.B., Vegas, A. and Brister, S. (2005) Thoracic complications of nasogastric tube; review of safe practice. Interactive Cardiovascular and Thoracic Surgery, 4(5), 429-433.
[8] Mc-Wey, R.E., Curry, N.S., Schabel, S.I. and Reines, D. (1988) Complications of nasoenteric feeding tubes. American Journal of Surgery, 155(2), 253-257.
[9] Bankier, A.A., Wiesmayr, M.N., Turetscheck, K., Mallek, R., Fleischmann, D., Janata, K. and Herold, C.J. (1997) Radiographic detection of intrabronchial malpositions of nasogastric tubes and subsequent complications in intensive care unit. Intensive Care Medicine, 23(4), 406-410.
[10] Theodore, A.C., Frank, J.A., Ende, J., Snider, G.L. and Beer, D.J. (1984) Errant placement of nasoenteric tubes. A hazard in obtunded. Chest, 86(6), 931-933.
[11] Kawati, R. and Rubertson, S. (2005) Malpositioning of fine bore feeding tube: A serious complication. Acta Anaesthsiol Scan, 49(1), 58-61.
[12] Tenholder, M., Erwin, W. and Nelson, H. (1994) Lost tidal volume in a 71-year old ventilated patient. Chest, 106(6), 1869-1871.
[13] Ibara-Perez, C. (1992) Perforation pulmonary por sonda de pequeno calibre para alimentation enteral. Rev Inv Clin, 44(2), 255-258.
[14] Druml, W., Gleinberg, G., Base, W., Haller, J., Laggner, A. and Lenz, K. (1984) Lung perforation by nasogastric feeding tubes. Clinical Nutrition, 2(3), 197-199.
[15] Hand, R., Kempster, M. and Levy, J. (1984) Inadvertent transbronchial insertion of narrow-bore feeding tube sinto the pleural space. Journal of the American Medical Association, 251(18), 2396-2397.
[16] Eldar, S. and Meguid, M. (1984) Pneumothorax following attempted nasogastric intubation for nutritional support. Journal of Parenteral and Enteral Nutrition, 8(4), 450-451.
[17] Valentine, J. and Turner, W. (1985) Pleural complications with nasoenteric feeding tubes. Journal of Parenteral and Enteral Nutrition, 9(5), 605-607.
[18] Wang, P.C., Tseng, G.Y., Yang, H.B., Chou, K.C. and Chen, C.H. (2008) Inadvertent tracheobronchial placement of feeding tube in a mechanically ventilated patient. Journal of the Chinese Medical Association, 71(7), 365- 367.
[19] Agarwal, A., Gaur, A., Sahu, D., Singh, P. and Pandey, C. (2002) Nasogastric tube knotting over the epiglottis: a ca- use of respiratory distress. Anesthesia & Analgesia, 94(6), 1659-1660.
[20] Stark, P. (1982) Inadvertent nasogastric tube insertion into the tracheobronchial tree. Radiology, 142(1), 239- 240.
[21] Balogh, G.J., Adler, S.J., Vander Woude, J., Glazer, H.S., Roper, C. and Weyman P.J. (1983) Pneumothorax as a complication of feeding tube placement. American Journal of Roentgenology, 141(6), 1275-1277.
[22] Trujillo, M.H., Fragachan, C.F., Tordoledo, F. and Ceballos, F. (2006) Lariat loop knotting of a nasogastric tube: An ounce of prevention. American Journal of Critical Care, 15(4), 413-414.
[23] Biggart, M., McQuillan, P., Choudrhry, A.K. and Nickalis, R.W. (1987) Dangers of placement of narrow bore nasogastric feeding tubes. Annals of the Royal College of Surgeons of England, 69(3), 119-120.
[24] Weinberg, L. and Skewes, D. (2006) Pneumothorax from intrapleural placement of a nasogatsric tube. Anaesth Intensive Care, 34(2), 276-279.
[25] Kolbitsch, C., Pomaroli, A., Lorenz, L., Gassner, M. and Luger, T.J. (1997) Pneumothorax following nasogastric feeding tube insertion in a tracheostomized patient after bilateral lung transplantation. Intensive Care Medicine, 23(4), 440-442.
[26] Miller, K.S., Tomlinson, J.R. and Sahn, S.A (1985) Pleuropulmonary complications of enteral tube feedings. Two reports, review of the literature and recommendations. Chest, 88(2), 230-233.
[27] Scholten, D.J., Wood, T.L. and Thompson, D.R. (1986) Pneumothorax from nasoeneteric feeding tube insertion. A report of five cases. American Journal of Surgery, 52(7), 381-385.
[28] Hensel, M. and Martniz, R. (2010) Pneumothorax following nasogastric feeding tube insertion. Case report and review of the literature. Anaesthesist, 31(2), (Epub Ahead of Print).
[29] Idu, S.R. and van de Leur, J.J. (1998) Iatrogenic tension pneumothorax following faulty positioning of gastric tube. Ned Tijdschr Geneeskd, 142(3), 142-145.
[30] Scheffenr, S.E., Gross, B.H., Birnberg, F.A. and Birk, P. (1985) Iatrogenic bronchopleural fistula caused by fee- ding tube insertion. Journal of Canadian Association Radiology, 36(1), 52-55.
[31] Nakao, M., Killam, D. and Wilson, R. (1983) Pneumothorax secondary to inadvertent nasotracheal placement of a nasoenteric tube past a cuffed endotracheal tube. Critical Care Medicine, 11(3), 210-211.
[32] Bautiista, E. (1988) Complications of nasogastric feeding tube insertion. Chest, 93(5), 1119-1120.
[33] Wu, P.Y., Kang, T.J., Hui, C.K., Sun, W.Z. and Chan, W.H. (2006) Fatal massive hemorrhage caused by nasogastric tube misplacement in a patient with mediastinitis. Journal of the Formosan Medical Association, 105(1), 80-85.
[34] Woodall, B.H., Winfield, D.F. and Bisset, G.S. (1987) Inadvertent tracheobronchial placement of feeding tubes. Radiology, 165(3), 727-729.
[35] Rousseau, P., Mulanu, C. and Aunac, S. (2006) Gastric foreign body. Rare complication of nasogastric tube placing. Annales Fran?aises d'Anesthèsie et de Rèanimation, 25(7), 777-779.
[36] Seguin, P., le Bouquin, V., Aguillon, D., Maurice, A., Lavioll, B. and Malledant, Y. (2005) Testing nasogastric tube placement: evaluation of three different methods in intensive care. Annales Fran?aises d'Anesthèsie et de Rèanimation, 24(6), 594-599.
[37] Metheny, A., Meert, K.L. and Clouse, R.E. (2007) Complications related to feeding tube placement. Current Opinion in Gastroenterology, 23(2), 178-182.
[38] Wendel, G.D., Lenchner, G.S. and Promisloff, R.A. (1991) Pneumothorax complicating small-bore feeding tube placement. Archives of Internal Medicine, 151(3), 599-602.
[39] Metheny, N.A. (2006) Acute complications associated with bedside placement of feeding tubes. American Journal of Critical Care, 21(1), 40-55.
[40] Hendry, P.J., Akyurekli, Y., McIntyre, R., Quarrington, A. and Keon, W.J. (1986) Bronchopleural complications of nasogastric feeding tubes. Critical Care Medicine, 14(10), 892-894.
[41] American Association of Critical Care Nurses Practice Alert (2005) Verification of feeding tube placement.
[42] Metheny, N. (2007) Confirmation of nasogastric tube placement. American Journal of Critical Care, 16(1), 19.
[43] Gombart, S., Khanna, A.K. and Gombar, K.K. (2007) Insertion of a nasogastric tube under direct vision: Another atraumatic approach to an old issue. Acta Anaesthesiol Scandinav, 51(7), 962-963.
[44] Jones, A.P., Diddee, R. and Bonner, S. (2006) Insertion of a nasogastric tube under direct vision. Anaesthesia, 61(3), 295-306.
[45] Roubenoff, R. and Ravich, W. (1989) Pneumothorax due to nasogastric feeding tubes. Archives of Internal Medicine, 149(2), 184-186.
[46] Lin, C.H., Liu, N.J., Lee, C.S., Tang, J.H., Wei, K.L., Yang, C., Sung K.F, Cheng, C.L., Chiu, C.T. and Chen, P.C. (2006) Nasogastric feeding tube placement in patients with oesophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest Endosc, 64(1), 104- 107.
[47] Thomas, B.W. and Falcone, R.E. (1998) Confirmation of nasogastric tube placement by colorimetric indicator detection of carbon dioxide: a preliminary report. Journal of the American College of Nutrition, 17(2), 195-197.
[48] Burns, S.M., Carpenter, R., Blevins, C., Bragg, S., Marsh- all, M. and Browne, L. (2006) Detection of inadvertent airway intubation during gastric tube insertion: capnometry versus a colorimetric carbon dioxide detector. American Journal of Critical Care, 15(2), 188-195.
[49] Reid, A. (2004) Feeding tube placement in the critically ill. Invited commentary. Journal of the American College of Surgeons, 199(1), 47-48.
[50] Haddad, N., Nawaz, T., Potter, L. and Lipman, T. (1993) Avoidance of nasopulmonary intubation by feeding tubes with stethoscopic guidance: “The Stethotube”. Gastroenterology, 104(5), A623.
[51] Bercik, P., Schlageter, V., Mauro, M., Rawlinson, J., Kucera, P. and Armstrong, D. (2005) Non-invasive verification of nasogastric tube placement using a magnet tracking system: A pilot study in healthy subjects. Journal of Parenteral and Enteral Nutrition, 29(4), 305-310.

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