Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 832-834

Pneumothorax after insertion of nasogastric tube

1 Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
2 Department of Internal Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Anaesthesia and Intensive Care, Stoke Mandeville Hospital, Stoke Mandeville, UK
3 Department of Critical Care, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia

Correspondence Address:
Muhammad Faisal Khan
Department of Anaesthesiology, Aga Khan University, Private Wing II, Stadium Road, P.O. Box 7400, Karachi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijrc.ijrc_4_17

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A 65-year-old man was admitted to the Intensive Care Unit (ICU) for invasive mechanical ventilation after a significant intraventricular bleed. When his nasogastric tube (NGT) was accidentally removed, a new NGT was inserted blind. The pH of the thick green aspirate was under five and so enteral feeding was restarted. However, the patient subsequently deteriorated with rapidly worsening respiratory failure and invasive ventilation was required. An X-ray revealed misplacement of the NGT into the right lung with consolidation, pleural effusion, and pneumothorax. This highlights that indirect techniques to check NGT position (e.g., air insufflation and abdominal auscultation, aspirate appearance and pH) are unreliable. Even X-ray only detects misplacement after the event and mistakes have occurred because previous X-rays from the same patient have erroneously been reviewed. Only real-time visualization can prevent bronchopulmonary misplacement and the associated risks of pneumothorax and microbial contamination. The authors' current practice is therefore to use laryngoscopy, endoscopy, or fluoroscopy for insertion of all NGT in patients in ICU with impaired airway protective reflexes.

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