Radiographic detection of intrabronchial malpositions of nasogastric tubes and subsequent complications in intensive care unit patients

• Published in: Intensive care medicine 1997-04, Vol.23 (4), p.406-410
• Main Authors: BANKIER, A. A, WIESMAYR, M. N, HENK, C, TURETSCHEK, K, WINKELBAUER, F, MALLEK, R, FLEISCHMANN, D, JANATA, K, HEROLD, C. J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bronchi - injuries; Critical Care - methods; Emergency and intensive care: techniques, logistics; Female; Humans; Intensive care; Intensive care medicine; Intubation; Intubation, Gastrointestinal - adverse effects; Male; Medical Errors - adverse effects; Medical sciences; Middle Aged; Ostomy; Patients; Perfusions. Catheterizations. Hyperbaric oxygenotherapy; Pleura - injuries; Pneumonia; Pneumonia - etiology; Pneumothorax; Pneumothorax - etiology; Radiography; Radiography, Thoracic; Retrospective Studies
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340050348

The aim of our study was to illustrate the radiographic spectrum of the intrabronchial malposition of nasogastric tubes and subsequent complications, and to discuss the role of radiography in the detection of such malpositions. Retrospective clinical investigation. Tertiary care university teaching hospital. We reviewed chest radiographs of 14 intensive care patients with nasogastric tubes malpositioned in the tracheobronchial tree. The site and anatomic location of the malposition were recorded. Complications due to tube malpositioning were monitored on follow-up radiographs and on computed tomographic examinations, which were available in 4 patients. Nine of 14 nasogastric tubes were inserted in the right and 5 in the left tracheobronchial tree. Tube tips were malpositioned in the lower lobe bronchi (50%), the intermediate bronchus (36%), and the main bronchi (14%). There was perforation of the bronchial system with subsequent pneumothorax in 4 patients. In 4 other patients, pneumonia developed at the former site of the malpositioned tube tip. Radiographic detection of nasogastric tube malpositioning was prompt in 9 patients and delayed in 5 patients. Whereas clinical signs of nasogastric tube malpositioning in intensive care patients may be absent or misleading, chest radiography can accurately detect nasogastric tube malpositions in the tracheobronchial tree, may prevent complications, and avoid the use of further costly or invasive diagnostic techniques.