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Iatrogenic Injury: Feeding Tubes


KEY FACTS

Terminology

  • Patient injury caused by improper feeding tube placement

  • Feeding tubes

    • Small, soft enteric tubes

    • Some with flexible metallic tips

    • Tip of feeding tube should be located beyond stomach (distal duodenum or jejunum)

  • Nasogastric tubes

    • Large bore, moderately stiff

    • Used for temporary gastric and bowel decompression

    • Tip placed in pylorus can cause outlet obstruction

  • Gastrostomy and jejunostomy tubes

    • Balloon-tipped catheters should not be placed into small bowel (may obstruct lumen)

    • Small amount of free air after placement is common and usually does not require intervention

Imaging

  • Malposition is most frequent complication of feeding tubes

    • Can be visualized on chest or abdominal radiograph

    • Auscultation over abdomen is not reliable method for confirming proper tube placement

Clinical Issues

  • 1-3% of feeding tubes enter tracheobronchial tree

    • Anywhere from trachea to pleural space

    • Can perforate lung with significant morbidity and mortality

  • Tube may penetrate esophagus or duodenum with fatal results

    • Often through diverticula (e.g., Zenker), due to thin wall

  • High-risk patients

    • Altered mental status

    • Absent gag reflex

    • Multiple or repetitive insertion attempts

  • Treatment

    • Reposition feeding tube if in incorrect location

    • Perforation of lung or bowel may require surgery

Esophagram shows a retroesophageal collection of gas and contrast medium
resulting from perforation of a Zenker diverticulum by attempted placement of a feeding tube whose track
runs parallel to the proximal esophagus
.

Chest radiograph shows a feeding tube
that has entered the right bronchus and perforated the lung though a lower lobe bronchus. The tip
lies in the pleural space, a procedural complication that may be fatal, especially if food is given through the tube.

Frontal radiograph shows the peculiar course of the feeding tube
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.

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

TERMINOLOGY

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