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Pulmonary injury secondary to feeding tube misplacement.

Resch TR, Price LA, Milner SM - Eplasty (2014)

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md.

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During her hospitalization a nasoenteric small bore feeding tube (SBFT) was placed in a blind fashion at the bedside... The patient has a large right-sided pneumothorax as a result of feeding tube misplacement into the airway... At first glance, these numbers may seem insignificant, however, if taken in the context of all feeding tube placements in the United States, this would translate into more than 3000 injuries and deaths per year... Note that the presence of a cuffed tracheal tube is not protective and instead may increase the risk of airway misplacement... In our case, a tracheostomy tube with an inflated cuff was in place and did not prevent the SBFT from entering the trachea... The tube preferentially went down the airway rather than the esophagus and easily passed the tracheal balloon with little to no resistance when examined fluoroscopically... Finally, greater clinician experience does not appear to decrease misplacements... Modalities to confirm SBFT placement range from simple bedside maneuvers to advanced technology using electromagnetic imaging... Commercially available electromagnetic devices are another tool designed specifically for bedside SBFT placement... Drawbacks include the cost of specialized SBFTs and the need for an available device with trained operators... Finally, fluoroscopy, direct laryngoscopy, and endoscopy are all nearly failsafe placement techniques but are impractical for routine use... In summary, bronchopulmonary SBFT misplacement is rare but can have significant consequences... The blind placement technique should be limited to noncritically ill patients with normal swallow function... Newer insertion techniques and devices represent safer options with few disadvantages.

No MeSH data available.


Plain films (a) of the abdomen following small bowel feeding tube placement and (b) of the chest after immediate removal of the tube.
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Figure 1: Plain films (a) of the abdomen following small bowel feeding tube placement and (b) of the chest after immediate removal of the tube.

Mentions: A 68-year-old female patient was admitted to the intensive care unit with severe burns and inhalation injury. During her hospitalization a nasoenteric small bore feeding tube (SBFT) was placed in a blind fashion at the bedside. Postplacement radiographs were obtained (Fig 1).


Pulmonary injury secondary to feeding tube misplacement.

Resch TR, Price LA, Milner SM - Eplasty (2014)

Plain films (a) of the abdomen following small bowel feeding tube placement and (b) of the chest after immediate removal of the tube.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128277&req=5

Figure 1: Plain films (a) of the abdomen following small bowel feeding tube placement and (b) of the chest after immediate removal of the tube.
Mentions: A 68-year-old female patient was admitted to the intensive care unit with severe burns and inhalation injury. During her hospitalization a nasoenteric small bore feeding tube (SBFT) was placed in a blind fashion at the bedside. Postplacement radiographs were obtained (Fig 1).

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, Baltimore, Md.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

During her hospitalization a nasoenteric small bore feeding tube (SBFT) was placed in a blind fashion at the bedside... The patient has a large right-sided pneumothorax as a result of feeding tube misplacement into the airway... At first glance, these numbers may seem insignificant, however, if taken in the context of all feeding tube placements in the United States, this would translate into more than 3000 injuries and deaths per year... Note that the presence of a cuffed tracheal tube is not protective and instead may increase the risk of airway misplacement... In our case, a tracheostomy tube with an inflated cuff was in place and did not prevent the SBFT from entering the trachea... The tube preferentially went down the airway rather than the esophagus and easily passed the tracheal balloon with little to no resistance when examined fluoroscopically... Finally, greater clinician experience does not appear to decrease misplacements... Modalities to confirm SBFT placement range from simple bedside maneuvers to advanced technology using electromagnetic imaging... Commercially available electromagnetic devices are another tool designed specifically for bedside SBFT placement... Drawbacks include the cost of specialized SBFTs and the need for an available device with trained operators... Finally, fluoroscopy, direct laryngoscopy, and endoscopy are all nearly failsafe placement techniques but are impractical for routine use... In summary, bronchopulmonary SBFT misplacement is rare but can have significant consequences... The blind placement technique should be limited to noncritically ill patients with normal swallow function... Newer insertion techniques and devices represent safer options with few disadvantages.

No MeSH data available.