Iatrogenic Injury: Feeding Tubes

Published on 09/08/2015 by admin

Filed under Radiology

Last modified 09/08/2015

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 Small, soft enteric tubes

image Some with flexible metallic tips
image Tip of feeding tube should be located beyond stomach (distal duodenum or jejunum)
• Nasogastric tubes

image Large-bore, moderately stiff
image Used for temporary bowel decompression
image Tip placed in pylorus can cause outlet obstruction
• Gastrostomy and jejunostomy tubes

image Balloon-tipped catheters should not be placed into small bowel (may obstruct lumen)
image Small amount of free air after placement is common and usually does not require intervention

IMAGING

• Malposition is most frequent complication of feeding tubes

image Can be visualized on chest or abdominal radiograph
image Auscultation over abdomen is not reliable method for confirming proper tube placement

CLINICAL ISSUES

• 1-3% of feeding tubes enter tracheobronchial tree

image Anywhere from trachea to pleural space
image Can perforate lung with significant morbidity and mortality
• Tube may penetrate esophagus or duodenum with fatal results

image Often through diverticula (e.g., Zenker), due to thin wall
• High-risk patients

image Altered mental status
image Absent gag reflex
image Multiple or repetitive insertion attempts
• Treatment

image Reposition feeding tube if in incorrect location
image Perforation of lung or bowel may require surgery
image
(Left) Esophagram shows a retroesophageal collection of gas and contrast medium image resulting from perforation of a Zenker diverticulum by attempted placement of a feeding tube whose track image runs parallel to the proximal esophagus.

image
(Right) Chest radiograph shows a feeding tube image that has entered the right bronchus and perforated the lung though a lower lobe bronchus. The tip image lies in the pleural space, a procedural complication that may be fatal, especially if food is given through the tube.
image
(Left) Frontal radiograph shows the peculiar course of the feeding tube image with abrupt upper deviation of its distal portion. CT showed that the tube had perforated the duodenum and had been advanced with its wire in place.

image
(Right) Axial CECT shows a feeding gastrostomy tube image entering the stomach. The balloon tip of the tube image has migrated into the jejunum where it is partially occluding its lumen.

TERMINOLOGY

Definitions

• Patient injury caused by improper feeding tube placement
• Feeding tubes

image Small, soft enteric tubes
image Some with flexible metallic tips
image Used for feeding chronically ill patients
image Can be used for long periods of time
• Nasogastric tubes

image Large-bore, moderately stiff

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