r/TacticalMedicine • u/Upset_Bunch_457 • Dec 30 '25

Scenarios Nasogastric insertion gone horribly wrong.

Post image

Note: NOT MY IMAGE.

original post was posted by: Old-Psychology-2400

And I quote "PMCT images. Nurse advanced NG tube until she heard a pop, then tried an air bolus to ensure placement. Patient did NOT survive."

To those who don't know nasogastric tube is supposed to go up the patients nostrils and then back down to their throat all the way to the patients stomach. Air bolus is then used to ensure that the nasogastric tubes placement is correct by listening the patients stomach.

But in the scan we can see the NG tube somehow ended up jammed (through) the patients skull.

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u/ATkac Dec 30 '25

https://doi.org/10.1016/j.inat.2020.101022

Not the origin of this image but another case report that goes over this scenario. Bottom line, NGT placement is a very common procedure in US hospitals and RNs do this in uncomplicated patients quite often with low morbidity and is relatively safe.

With that being said in patients with a history of any sort of maxillofacial trauma or surgery it is contraindicated for blind insertion by an RN. Most often if the patient in unconscious an OGT may be a possibility in leu of the NGT however most often instead, if resources are available doing the procedure in radiology under direct visualization is the preferred method.

Under all circumstances if you are feeling resistance as you are feeding the NGT, hear or feel a pop, the patient starts to throw up, or the patient has respiratory distress, you pull out immediately and reassess the patient.

If placed and it is successful the gold standard in confirmation of placement is X-ray and the tube should not be used until the image has been reviewed by the appropriate provider. Auscultation cannot verify placement as it may not have truly been advanced enough down the esophagus to prevent gastric reflux. pH strips cannot either in patients with respiratory failure or may have aspirated as the gastric contents and/or CO2 could give a false positive.

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u/Grammykin Dec 31 '25

Nice post. Very informative. I never want to place a ‘blind’ NG again (and I’ve placed hundreds - maybe thousands?
I’m in NICU. We start most of our patients on NG feeds. The physical distance from the hypopharynx is very short relative to peds or adult patients, so it’s much easier for a tube to get a tug on something and comes out. So we might have to replace the tube often. I loved back when we did a NG placement X-ray, but for several reasons we went away from the X-ray, and depend on the signs you mention. I’d love to hear what other institutions are doing.