A near miss; malpositioned nasogastric tube in the left bronchus of a spontaneously breathing critically-ill patient

Abstract

Nasogastric gastric tubes (NGT) are placed blindly at the bedside in critical care although the procedure is associated with occasional serious pleuro-pulmonary complications. Various factors have been reported to predispose to the feeding tube malposition. We report a 60-year male in whom the attempted NGT insertion led to a near fatal complication. He was admitted to the medical intensive care-unit of our institute with dysphagia, cough with expectoration and breathlessness. In an un-cooperative patient with ineffective cough, the administration of sedation and multiple attempts to place the NGT resulted in an impacted tooth in the upper esophagus, and misplacement of the NGT. An urgent chest radiograph showed that the NGT had entered into the airway and its tip lay in the left main bronchus. A brief review of the complications associated with NGT insertion is presented.