From episode 163 on the ECC feed. With Dr Abbie Tippler and Dr Ellie Leister.
What do you think about the placement of this NG feeding tube?
What if I told you that that tube had passed down a bronchus, THROUGH the lung parenchyma, and into the pleural space! (Look closely more cranially.) Dr Abbie shared this case with us to highlight this very real, very catastrophic risk of NG tube placement. I highly encourage you to listen to this episode, but here are the 2 key takeaways on how to prevent this:
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If your patient is anaesthetised when you place the tube, visualise the tube entering the oesophagus in the pharynx. Ie - one person shoves the tube up the nose, while someone else looks into the mouth with a light to see the little bugger go where it’s supposed to.
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Pass the tube up to the thoracic inlet (pre-measure), then STOP and take an X-ray. It’s easy to see it sitting in the trachea at this point if you’re in the wrong pipe. If you only take your rad AFTER you’ve passed it all the way to what you think is the stomach IT’S TOO LATE - you may have already pushed it through the lung. (And no, you won’t feel huge resistance when you’re drilling through the lung parenchyma with your tube!)
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