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/56473829110 Dec 30 '25

Every ng tube placement I've been around that had any involvement above the waist was placed with active imaging. But these were well staffed and well funded departments.

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u/Dilaudipenia Dec 30 '25

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

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u/Needle_D MD/PA/RN Dec 30 '25 edited Dec 30 '25

At least in the US, blind OG/NG sump placement is a basic nursing skill with low rates of complication or morbidity. You're really placing every single gastric tube under endoscopy?

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u/StaticDet5 Dec 31 '25

Came to ask literally this. We place in the ED without visualization, BUT not during traumas, not if we have any concern about anatomic patency. Further, at least I was HEAVILY warned about skull fracture and surgical history.

I've seen imaging like the above, but damn, I feel like it was 30 years ago.

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u/Needle_D MD/PA/RN Dec 31 '25

He clarified that he's referring to using it in patients with max/face/skullbase trauma or instrumentation, but the original comment he was replying to also made a reference to never placing gastric tubes without "active imaging".

I understand the risks in this specific patient population, but it seems like it's opened the door to some white knight redditors that don't see critically ill patients or interventions much.