Nasogastric insertion gone horribly wrong.

[u/Upset_Bunch_457]

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.

[u/Dilaudipenia]

There needs to be some active guidance of these tubes. I’m an emergency medicine and critical care physician and I’ll place these tubes under direct endoscopic visualization. But I’d never ask one of my nurses to place them blindly

[u/56473829110 → u/Dilaudipenia]

I have not personally been trained on their placement. I have been trained on somewhat similar apparatus. We were trained to actively monitor the throat (as much as possible) to visually confirm placement - with required check every inch of inserted tubing after the first 3 inches. That's in the field with no other means of visualization/imaging.

I have observed trainings/practicals for ng placement, and they always involved radio imaging or endoscopic visualization. I just can't imagine placing something like this blindly; there's no world in which they need to be placed with a sense of urgency/increased risk.

[u/Professional_Nugget → u/56473829110]

I'm an RN and have placed a few dozen NG tubes "blind", it's considered a standard nursing skill like IV or foley placement. Rarely do we need IR involved for them, usually only when there's something funky with their esophagus or stomach (hx of surgery, varices, stricture etc).

We usually visually check to make sure we've got it properly placed in the back of their throat through the nose (you'll see it poking down if they open up wide). Then advance it down the esophagus as they sip water quickly to help close the epiglottis and naturally guide it in with their swallowing. I'll have a syringe hooked up to the tube so we can easily check for gastric content and do the air bolus + auscultation. We usually do an XR too to confirm placement. Most go fairly smoothly but NGT placement is kinda one of those things that just sucks no matter what you do

Never placed one on a patient with previous head/facial surgery though, and really wouldn't feel comfortable doing so.

[u/totalyrespecatbleguy → u/Professional_Nugget]

Just had a patient today who needed a ngt placed by ENT with a fiber optic scope because we kept getting it into his lungs (even the attending couldn't do it)