Uncommon complication of nasoenteral feeding tube:A case report

CASE PRESENTATlON

Chief complaints

A 74-year-old male patient who with a history of chronic obstructive pulmonary disease(COPD)was admitted to the intensive care unit(ICU)for aspiration pneumonia and respiratory failure.

History of present illness

He had a prolonged course of treatment and a nasoduodenal feeding tube blind placed at the bedside.

Imaging examinations

A chest X-ray revealed that the position of the nasoduodenal feeding tube was in the chest(Figure 1A).An abdominal X-ray also made it clear that the nasoduodenal feeding tube was not placed in the abdomen(Figure 1B).Visual laryngoscopy revealed that the tube entered the airway together with the windpipe(Figure 2).

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FlNAL DlAGNOSlS

The patient suffered from pneumothorax due to tracheal pleura leakage,which occurred when the feeding tube was immediately removed.

TREATMENT

The most commonly used non-invasive method of enteral nutrition is a nasogastrojejunal tube.The jejunal nutrition tube has increasingly been used in clinical practice,and the results in frequent complications[4,5].The traditional method of intubation depends on the operator experience,X-ray,and gastroscope.Nasogastrojejunal tube insertion based on a minimally invasive catheterization procedure,combined with ultrasound guidance,is becoming more prevalent[6].The use of bedside ultrasound to guide the placement of the jejunal tube is safe,convenient and economical.One of the common complications of indwelling jejunal tubes is the misplaced airway as reported in this case.How can we avoid it? When the cannula is about 30 cm,we need to observe the patient's response and ventilator condition.Even neck ultrasound determines access to the esophagus.If the patient has a severe cough response or a leak and a high pressure alarm,it may suggest that the tube has entered the airway.When the tube is placed around 50 cm,we need to complete a test of pumping.If you can hear the gas over water(bubble sound),then the catheter head has entered the stomach.If not,the patient should be reintubated.

OUTCOME AND FOLLOW-UP

However,the patient died as a result of the aggravation of the lung infection.

DlSCUSSlON

We administered chest drainage in the middle of the clavicle and second ribs.

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CONCLUSlON

The complication of blind bedside jejunal feeding tube placement was a disaster.Ultrasound guidance under visualization can avoid serious complications.Practitioners need to pay attention to patient response and the ventilator during catheterization.