Complicated placement of a nasogastric tube in the gastric mucosa: A case report and literature review.
Yiqi Zhang, Yuzhi Gao, Linyan Zeng and 2 others
PMID 39392085WHAT IT FOUND
In an ICU patient, a nasogastric tube appeared correctly placed on X-ray but had tunneled through gastric mucosa.
Bloody drainage and falling haemoglobin prompted endoscopy, and the tube was removed under direct vision.
Key findings
01A nasogastric tube that looked correctly positioned on X-ray had actually tunneled through the gastric mucosa.
02After NGT insertion, bloody gastric drainage and haemoglobin changes occurred despite stable blood pressure.
03After tube removal under gastroscopic guidance and placement of a new tube, fasting and antacid treatment preceded stabilization of drainage and haemoglobin.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report, so it cannot show how often this complication occurs or that validation methods usually fail. The literature review is not described as systematic, so the cited complications and methods may not represent all available evidence. No pH testing was performed in the reported patient, and the authors identify this as a gap. Improvement followed tube removal under gastroscopic guidance, placement of a new tube, fasting, and antacid treatment. The effect of each step cannot be separated. The patient had recent imaging suggesting a lesion near the cardia, so his mucosa may have been unusually vulnerable. This may not apply to all patients.
The easy way to misread this
Do not conclude that X-ray or whooshing tests routinely miss gastric mucosal placement. This is a case report, not evidence of how often this happens.