Iatrogenic Injury: Feeding Tubes

 Small, soft enteric tubes


image Some with flexible metallic tips

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


• Nasogastric tubes
image Large-bore, moderately stiff

image Used for temporary bowel decompression

image Tip placed in pylorus can cause outlet obstruction

• Gastrostomy and jejunostomy tubes
image Balloon-tipped catheters should not be placed into small bowel (may obstruct lumen)

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




IMAGING




• Malposition is most frequent complication of feeding tubes
image Can be visualized on chest or abdominal radiograph

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


CLINICAL ISSUES




• 1-3% of feeding tubes enter tracheobronchial tree
image Anywhere from trachea to pleural space

image Can perforate lung with significant morbidity and mortality

• Tube may penetrate esophagus or duodenum with fatal results
image Often through diverticula (e.g., Zenker), due to thin wall

• High-risk patients
image Altered mental status

image Absent gag reflex

image Multiple or repetitive insertion attempts

• Treatment
image Reposition feeding tube if in incorrect location

image Perforation of lung or bowel may require surgery

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


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

image
(Left) Frontal radiograph shows the peculiar course of the feeding tube image 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.


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


TERMINOLOGY


Definitions




• Patient injury caused by improper feeding tube placement

• Feeding tubes
image Small, soft enteric tubes

image Some with flexible metallic tips

image Used for feeding chronically ill patients

image Can be used for long periods of time

Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Iatrogenic Injury: Feeding Tubes

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