Figure 4. Key features of the NGT/NET-related adverse events described in included articles. Ribeirão Preto, SP, Brazil, 2018.
| Article Number |
Study Aim | Study Type | Main Results |
|---|---|---|---|
| Esophageal or pharyngeal complications | |||
| 45 | To report a case that illustrates circumstances in which a narrow bore NGT* was misplaced and where there could have been serious consequences. | Case report | An NGT* was inserted in a 66-year-old patient. There was resistance during the insertion and a new attempt was made. During the pH check, results were found outside the normal range. A radiograph was performed and esophageal perforation was detected. The tube pierced the mediastinum and punctured the pleura. The tube was removed and the patient received antibiotic treatment. |
| 46 | To show that an acute and potentially life-threatening situation may arise after uneventful passage of an NET†. | Case report | After blind insertion of an NET†, a 56-yearl-old woman had large nasal bleeding. The tube punctured the right internal jugular vein and traversed the superior vena cava and the right atrium. She was quickly intubated to ensure patent airway and two liters of blood were drained. Vasoactive medication and intravenous blood infusion were also started. Patient was transferred to another hospital. |
| 47 | To describe the clinical histories of two representative cases among the four patients and discuss the etiology of this variant form of NGT* syndrome. | Case report | After prolonged use of an NGT*, one patient developed laryngeal stridor and severe vocal cord paralysis, as evidenced by laryngoscopy. The patient progressed to severe respiratory disease and died. In the second case, the patient presented laryngeal stridor, vocal cord paralysis and glottic space crack after NGT* removal. After two months, the patient presented exacerbated stridor and died due to respiratory failure. |
| 48 | To report a case of fatal hemorrhagic shock immediately after NGT* insertion in a patient undergoing debridement by video- assisted thoracoscopic surgery for mediastinitis. | Case report | An NGT* was inserted in a 70-year-old woman. During transport to the ICU‡, the tube was accidentally pulled out and it was replaced by the surgeon. After three attempts, there was a large amount of bleeding through the tube and vital signs changed dramatically, with a decrease in blood pressure and heart rate. Resuscitation maneuvers were initiated and the opening of the ribcage was necessary for direct cardiac compression. Four liters of blood were drained. Endoscopy revealed esophageal perforation, which caused bleeding. The tube was removed by endoscopy. Two days after the event, the pupils became fixed and the patient died. |
| 49 | To report a case of a 70 year-old woman who presented acute dyspnea, requiring emergency tracheotomy following prolonged nasogastric intubation. | Case report | Patient required an NGT* for enteral nutrition. After five weeks, a new tube was needed and after the insertion, the patient presented laryngeal stridor, vocal cord paralysis and arytenoid edema. Urgent tracheostomy was required. The tube was removed and parenteral nutrition was started. The patient gradually recovered vocal cord mobility and was diagnosed with Nasogastric Tube Syndrome. |
| Esophageal or pharyngeal complications | |||
| 50 | To present a case that highlights the benefits of carrying out an X-ray to confirm the position of a nasogastric tube. | Case report | An NGT* for enteral nutrition was inserted in a 50-year-old man. After two weeks, the tube was inserted several times due to accidental removal. On one occasion, the patient reported traction of the tube while sleeping, but the tube was not found. A new tube was inserted and its tip position was confirmed by radiography. The x-ray revealed that the tube had been inserted into the left main bronchus. It also revealed that the first tube was in the hypopharynx region and the other end was in the stomach. The "lost" tube was removed by esophagoscopy and there were no complications to the patient. |
| 51 | To report an unexpected cause of malfunctioning NGT* due to non apparent misplacement. | Case report | An NGT* was blindly inserted in a 68-year-old man and positioning was confirmed by abdominal radiography. Enteral nutrition was started and the patient had vomiting. The attending physician reviewed the x-ray showing positioning of the tube in the esophagus. |
| 52 | To present a case of nasopharyngeal perforation caused by electromagnetically visualized feeding tube system. | Case report | NET† was inserted with an electromagnetic device in a 50-year-old woman and mechanically ventilated. Resistance occurred during insertion; patient showed signs of respiratory distress and right side dilation of the face. A tomography showed perforation of the right nasopharynx. The tube traversed the anterior carotid artery, the internal jugular vein, and the parotid gland. |
| Tube obstruction | |||
| 53 | To describe the management of patients treated with enteral nutrition and to identify complications and mortality. | Prospective observational study | From 108 patients included in the study, 45 used NET†, 62 used gastrostomy and one patient had jejunostomy. The following complications were observed: aspiration (15%); accidental removal (62%) and tube obstruction (11%). The mortality rate was 23% in one year and the average survival was 674 days. |
| 54 | To identify adverse events related to enteral nutrition in hospitalized patients | Longitudinal exploratory study | 46 patients were observed and the most common adverse events were: accidental removal (43%) and tube obstruction (21%). Nausea and vomiting were also recorded. |
| 55 | To report a case of a patient who developed an esophageal bezoar due to malpositioning of an NGT*. | Case report | An NGT* was inserted into a 20-year-old patient. Positioning was confirmed by auscultation. Patient had aspiration pneumonia and the nurse found tube obstruction. A new tube was inserted and, again, obstruction was detected due to bezoar. |
| Intestinal perforation | |||
| 56 | To describe a case where insertion of an NGT* caused intestinal perforation in a patient who had previously undergone Roux-en-Y gastric bypass. | Case report | An orogastric tube was inserted in a 59-year-old patient for gastric decompression. Positioning was confirmed by radiography. In the ICU‡, the tube was replaced by an NET†. On the 28th day, a new NET† was inserted and 11 days later, a distended abdomen and absence of airborne noises were observed. The patient progressed to clinical worsening and on the 39th day, the patient died. At necropsy, intestinal perforation was found in the bypass region caused by the insertion of the last tube. |
| Intracranial perforation | |||
| 57 | To describe a case in which a patient who had suffered severe facial fractures erroneously had an NGT* placed in the intracranial cavity. | Case report | A 34-year-old woman falls from the height of a building and suffers head and neck trauma. An NGT* was blindly inserted for gastric decompression and minutes later the patient had dilated pupils, ataxic breathing, and flaccid body. Radiography revealed that the tube surpassed the cribriform plate and that the distal tip was inserted into the intracranial cavity. The patient's condition deteriorated and she died after one hour. |
| 58 | To report a case of inadvertent intracranial complication directly related to the placement of an NGT* in a patient who had no history of head trauma. | Case report | An NGT* was inserted into a conscious and oriented 45-year-old woman with no previous history of head injury. During the insertion, there was return of live blood in the tube. The procedure was continued and the auscultation test was negative. The tube was removed and the patient became irresponsive. Computed tomography revealed subdural pneumocephalus of the skull and sinusitis in the frontal sinuses, with air collections. |
| 59 | To report a case of inadvertent intracranial placement of an NGT* in a non-trauma patient. | Case report | An NGT* was inserted into a 59-year-old woman. Three attempts were made and blood returned in all. In the third attempt, an x-ray was performed, which found the presence of the tube in the brain. The tube was removed, but the patient died of sepsis. |
| 60 | To describe a case of severe craniofacial fracture in which an NGT* was positioned intracranially. | Case report | An NGT* was inserted into a 38-year-old man with skull and facial bone base fractures. There were no clinical signs showing NGT* misplacement. After computed tomography, it was found that the tube was located in the cranial fossa. |
| 61 | To describe a case of severe craniofacial fracture in which the NGT* was positioned intracranially. | Case report | NGT* was inserted in a 53-year-old man with polytraumas. Skull base fracture was found and computed tomography revealed traumatic subarachnoid hemorrhage. The exam also revealed that the NGT* crossed the cribriform plate and reached the posterior cranial fossa. The tube was removed and the patient was transferred to the ICU‡. A drain was installed as well as a transducer for intracranial pressure monitoring. The next day, the patient presented hemiplegia on the right. The patient was only discharged after 80 days of hospitalization with neurological complications. |
| Unplanned Tube Removal | |||
| 62 | To characterize the rates of accidental removal of endotracheal tubes, vascular catheters, and nasogastric tubes in the critically ill patient. | Prospective observational study | In total, 532 ICU‡ patients were included and 913 NGT* were inserted. Regarding accidental withdrawal, 312 cases were reported, and the most common reason was withdrawal by the patient her/himself. |
| 63 | To characterize adverse events in ICU‡, Semi-Intensive Care Units and Inpatient Units, regarding nature, type, day of the week and nursing professionals/patient ratio at the moment of occurrence; as well as to identify nursing interventions after the event. | Retrospective observational study | The main adverse events were related to NGT*/NET†: 69.6% were caused by accidental removal and 54.10% by tube obstruction. |
*
NGT = Nasogastric tube;
†
NET = Nasoenteric tube;
‡
ICU = Intensive Care Unit