Presentation
NG tube insertion in an ICU patient with decompensated liver disease
Patient Data
Nasogastric tube (NGT), with the distal tip projected over the mid T-spine, likely within the esophagus, and must not be used.
Right-sided internal jugular vein (IJV) dual-lumen catheter in reasonable position.
Bilateral patchy consolidation consistent with non-cardiogenic pulmonary edema.
Nasogastric tube (NGT), curled up in the neck, and must not be used.
Right-sided IJV dual-lumen catheter as previously.
Bilateral patchy consolidation consistent with non-cardiogenic pulmonary edema.
Mobile AP semi-erect on ICU later same day
Nasogastric tube (NGT), with the distal tip in the left main bronchus, and must not be used.
Right-sided IJV dual-lumen catheter as previously.
Bilateral patchy consolidation consistent with non-cardiogenic pulmonary edema.
Mobile AP semi-erect on ICU later same day
Nasogastric tube (NGT), with the distal tip in the right main bronchus, and must not be used.
Right-sided IJV dual-lumen catheter as previously.
New endotracheal tube (ETT) and left-sided IJV dual-lumen catheter in reasonable position.
Bilateral patchy consolidation consistent with non-cardiogenic pulmonary edema.
Mobile AP semi-erect on ICU later same day
Limited coverage chest radiograph, x-ray not repeated as primary reason was to assess NG tube position.
Normally-sited NG tube, with its tip under the left hemidiaphragm.
Other catheters and tubes as before.
Case Discussion
Commonly, nasogastric tubes (like all nasoenteric tubes) are inserted blindly. Malposition is seen in anything from 0.5 to 16% cases. Incorrect positioning may include tracheal, bronchial or pleural spaces, with potential sequelae of infusion of feed into the lung/pleural cavity, pneumothorax or lung abscess. Traditional methods of checking tube position, e.g. air via tube and auscultation are notoriously inaccurate and must not be relied upon. Radiographic validation is the best way if any doubt exists 1.
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