Pulmonary Complications of 9931 Narrow-Bore Nasoenteric Tubes During Blind Placement: A Critical Review
enteral access; enteral nutrition; feeding tubes; GI access; insertion; nasogastric tube; nutrition; Nutrition & Dietetics; outcomes; patient safety; public policy; research/quality
Introduction: A critical review of the pulmonary complications associated with blind placement of narrow-bore nasoenteric tubes (NETs) is discussed. Preventive measures and placement techniques are addressed to decrease patient morbidity and mortality. Methods: A thorough database review was conducted to identify all randomized controlled and retrospective trials specifically addressing pulmonary complications from narrow-bore NET placement. Five unique studies, comprising more than 9900 NET placements, were identified. On the basis of the literature reviewed, the authors identified 3 major complications associated with blind NET placement: patient mortality directly resulting from NET misplacement, incidence of tracheopulmonary malpositioning, and correlation between NET misplacement and mechanical ventilation. Results: Of the 9931 NET placements reviewed, there were 187 total improper tube placements in the tracheobronchial tree, which translates to a 1.9% mean overall malposition rate. Of these 187 misplacements, there were 35 (18.7%) reported pneumothoraces, at least 5 of which resulted in patient death. NET malpositioning was reported in 13%-32% of subsequent repositioning attempts. This increased risk exposes the patient population to a cumulative mortality from tracheobronchial malpositioning approaching > 20%. Unexpectedly, of the 187 total misplacements, 113 (60.4%) of the patients were mechanically ventilated. Conclusions: Practitioners need to be aware of the potential for pulmonary complications associated with blind NET placement. Changes in institutional protocol should be considered to minimize unnecessary risks. As with any procedure, experienced personnel should be primarily used for tube placement and responsible for assisting others with less familiarity to learn the proper methods. (JPEN J Parenter Enteral Nutr. 2011; 35: 625-629)
Sparks D A; Chase D M; Coughlin L M; Perry E
Journal of Parenteral and Enteral Nutrition
2011
2011-09
Journal Article
<a href="http://doi.org/10.1177/0148607111413898" target="_blank" rel="noreferrer noopener">10.1177/0148607111413898</a>
INCARCERATED SMALL BOWEL ASSOCIATED WITH ELECTIVE ABORTION UTERINE PERFORATION
complications; injury; Emergency Medicine; management; small bowel obstruction; elective abortion; incarcerated bowel; surgical abortion; trimester; uterine perforation
Background: Uterine perforation is a rare but recognized complication of abortion. Perforations may not be recognized at the time of the procedure, and patients may present days or weeks later with sequelae of the complication. Objectives: To raise awareness of this rare complication that can present days to weeks after the precipitating event. Case Report: A 21-year-old woman presented 3 weeks after an elective abortion with symptoms of bowel obstruction. Exploratory laparotomy revealed small bowel herniation into a perforated uterus, causing the obstruction. In retrospect, a pre-operative ultrasound and computed tomography (CT) scan suggested this finding, but it went unrecognized at that time. A small bowel resection was performed and the patient made an uneventful recovery. Conclusion: Intrauterine bowel after abortion has been described only a handful of times in the literature. Uterine perforation during abortion is usually asymptomatic and generally can be managed conservatively, but herniation of bowel through the uterine defect can result in obstruction and strangulation. Intrauterine bowel requires prompt laparotomy and possible resection of non-viable bowel. Although ultrasound and CT scans may aid in diagnosis of this rare complication, a clinical suspicion for uterine perforation should be maintained by health care providers when treating patients who have had an abortion. (C) 2013 Elsevier Inc.
Coughlin L M; Sparks D A; Chase D M; Smith J
Journal of Emergency Medicine
2013
2013-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.jemermed.2012.02.071" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2012.02.071</a>