Diagnosis and Management of a Misplaced Nasogastric Tube Into the Pulmonary Pleura

Asignificant number of patients undergoing surgery for disorders of the head and neck will receive a Dobbhoff tube or a nasogastric (NG) tube. The tube placement may be used for the short term, to get patients through a critical illness, or for the long term, when patients need nutritional supplementation for an extended period. The feeding tube may be placed in the operating room with the patient under general anesthesia or at the bedside in a regular hospital setting. Many methods of monitoring the correct placement of the feeding tube have been described. Recently, in our institution, feeding tubes were placed into the lungs or pleural space in 3 cases, including 1 case on the otolaryngology service. Whilethemostcommoncomplicationsof NGtubeplacementarerelatedtothelongterm effects of feeding, such as nausea, placement in the lungs or in the pleural space has been recognized in fewer than 1% of cases. 1 The sequelae of an unrecognized misplaced feeding tube include pneumonitis, pneumonia, and pleural effusions, with the possibility of empyema. We discuss the presentation and subsequent hospital course in this case to demonstrate a paradigm for ascertaining the correct placement of a feeding tube. We also describe the current management of the misplaced tube whereby feedings are deliveredtothelungsorthepleuralspace. Dobbhoff or NG tube placement is commonly used in head and neck surgery cases either for short-term use during a critical illness or for a longer period during treatment rehabilitation. These feeding tubes may be placed in the operating room with the patient under an anesthetic or at the bedside in a regular hospital setting. Many methods of monitoring the correct placement of the feeding tube have been described.