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Limitations of Routine Verification of Nasogastric Tube Insertion Using X‐Ray and Auscultation
Author(s) -
Nejo Takahide,
Oya Soichi,
Tsukasa Tsuchiya,
Yamaguchi Naomi,
Matsui Toru
Publication year - 2016
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/0884533616648324
Subject(s) - medicine , auscultation , feeding tube , surgery , radiology
Several bedside approaches used in combination with thoracoabdominal X‐ray are widely used to avoid severe complications that have been reported during nasogastric tube management. Although confirmation by X‐ray is considered the gold standard, it is not yet perfect. We present 2 cases of rare complications in which the routine verification methods could not detect all the complications related to the nasogastric tube placement. Case 1 was a 17‐year‐old male who presented with a brain tumor and repeatedly required nasogastric tube placement. Despite normal auscultatory and X‐ray findings, the patient's condition deteriorated rapidly after resuming the enteral nutrition (EN). Computed tomography images showed the presence of hepatic portal venous gas (HPVG). Urgent upper gastrointestinal endoscopy showed esophagogastric submucosal tunneling of the tube that required an emergency open total gastrectomy. Case 2 was a 76‐year‐old man with long‐term EN after stroke. While the last auscultatory verification was normal, he suddenly developed extensive HPVG due to gastric mucosal injury following EN, which resulted in progressive intestinal necrosis, general peritonitis, and death. These 2 cases indicated that routine verification methods consisting of auscultation and X‐ray may not be completely reliable, and the awareness of the limitations of these methods should be reaffirmed because expeditious examinations and necessary interventions are critical in preventing life‐threatening complications.