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{{ | '''Associate Editor-In-Chief:''' {{CZ}} | ||
===Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient | |||
==Misplaced nasogastric tube== | |||
* What happens if the Nasogastric tube is too high? | |||
** Aspiration | |||
* What happens if the Nasogastric tube is in the trachea or a bronchus? | |||
** Aspiration | |||
** Hypoventilation | |||
* Can intracranial insertion of a Nasogastric tube occur? | |||
**Yes. Especially in trauma patients. | |||
===Case #1: Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient with Severe Craniofacial Trauma=== | |||
* 35 cases of intracranial nasogastric tube insertion have been reported in the international literature. <ref>Journal of Oral and Maxillofacial Surgery - http://www.sciencedirect.com/science/journal/02782391</ref> <ref>Paloma Rodrigues Genú, David Moraes de Oliveira, Ricardo José de Holanda Vasconcellos, Ricardo Viana Bessa Nogueira and Belmiro Cavalcanti do Egito Vasconcelos. [http://dx.doi.org/10.1016/j.joms.2004.07.005 Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: A case report.] Journal of Oral and Maxillofacial Surgery. 2004. 62: 1435-1438.</ref> | * 35 cases of intracranial nasogastric tube insertion have been reported in the international literature. <ref>Journal of Oral and Maxillofacial Surgery - http://www.sciencedirect.com/science/journal/02782391</ref> <ref>Paloma Rodrigues Genú, David Moraes de Oliveira, Ricardo José de Holanda Vasconcellos, Ricardo Viana Bessa Nogueira and Belmiro Cavalcanti do Egito Vasconcelos. [http://dx.doi.org/10.1016/j.joms.2004.07.005 Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: A case report.] Journal of Oral and Maxillofacial Surgery. 2004. 62: 1435-1438.</ref> | ||
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<br clear="left"/> | <br clear="left"/> | ||
== | ===Case #2: Nasogastric tube in lung === | ||
[[Image:Nasogastric tube in lung 001.jpg|left|thumb|300px|Nasogastric tube in right lung]] | |||
<br clear="left"/> | |||
[[Image:Nasogastric tube in lung 002.jpg|left|thumb|300px|Nasogastric tube in right lung]] | |||
<br clear="left"/> | |||
==Misplaced endotracheal tube== | |||
*What happens if the endotracheal tube is '''too high'''? | |||
**Endotracheal tube can rub against the vocal cords and cause cord trauma. | |||
*What happens if the endotracheal tube is '''too low'''? | |||
**Endotracheal tube can selectively intubate the right or left mainstem bronchus. | |||
*'''Esophagus''' can also be intubated | |||
**Suspect esophageal intubation when there is progressive gaseous distention of the stomach while the lung volumes remain low. | |||
[http://www.radswiki.net Images courtesy of RadsWiki] | |||
[[Image:Endotracheal tube in right mainstem bronchus 001.jpg|left|thumb|300px|No left breath sounds post intubation: ETT in right mainstem bronchus]] | |||
<br clear="left"/> | |||
[[Image:Endotracheal tube in right mainstem bronchus 002.jpg|left|thumb|300px|ETT pulled back and now in good position]] | |||
<br clear="left"/> | |||
[[Image:Esophageal-intubation-001.jpg|left|thumb|300px|Esophageal intubation]] | |||
<br clear="left"/> | |||
==Misplaced central lines (CVP catheters)== | |||
===PICC from [[left superior vena cava]] to coronary sinus to right atrium to inferior vena cava to left hepatic vein=== | ===PICC from [[left superior vena cava]] to coronary sinus to right atrium to inferior vena cava to left hepatic vein=== | ||
[[Image:Misplaced-PICC-301.jpg| | [http://www.radswiki.net Image courtesy of RadsWiki] | ||
[[Image:Misplaced-PICC-301.jpg|300px|left|thumb|]] | |||
<br clear="left"/> | <br clear="left"/> | ||
===Coiled in Axillary=== | ===Coiled in Axillary=== | ||
[[Image:PICC-placement-CR-001.jpg]] | [http://www.radswiki.net Images courtesy of RadsWiki] | ||
[[Image:PICC-placement-CR-001.jpg|300px|left|thumb|]] | |||
<br clear="left"/> | |||
[[Image:PICC-placement-CR-001 copy.jpg|300px|left|thumb|]] | |||
<br clear="left"/> | <br clear="left"/> | ||
[[Image: | ==Misplaced umbilical venous catheters== | ||
===UVC through PFO=== | |||
[http://www.radswiki.net Image courtesy of RadsWiki] | |||
[[Image:UVC-through-PFO-001.jpg|300px|left|thumb|]] | |||
<br clear="left"/> | |||
===UVC in SMV=== | |||
[http://www.radswiki.net Image courtesy of RadsWiki] | |||
[[Image:UVC-in-SMV-001.jpg|300px|left|thumb|]] | |||
<br clear="left"/> | |||
==Misplaced Foley catheter== | |||
===A patient with suprapubic pain after the Foley catheter insertion === | |||
[http://www.radswiki.net Images courtesy of RadsWiki] | |||
[[Image:Misplaced-foley-001.jpg|left|thumb|300px|Misplaced Foley catheter (The catheter placed into patients uterus)]] | |||
<br clear="left"/> | |||
[[Image:Misplaced-foley-002.jpg|left|thumb|300px|Misplaced Foley catheter (The catheter placed into patients uterus)]] | |||
<br clear="left"/> | |||
==Misplaced gastrostomy tube== | |||
[http://www.radswiki.net Images courtesy of RadsWiki] | |||
[[Image:Transhepatic-G-tube-001.jpg|left|thumb|300px|A gastrostomy tube in the liver]] | |||
<br clear="left"/> | |||
[[Image:Transhepatic-G-tube-002.jpg|left|thumb|300px|A gastrostomy tube in the liver]] | |||
<br clear="left"/> | |||
[[Image:Transhepatic-G-tube-004.jpg|left|thumb|300px|A gastrostomy tube in the liver]] | |||
<br clear="left"/> | |||
[[Image:Misplaced-PEG-101.jpg|left|thumb|300px|Misplaced balloon inflation]] | |||
<br clear="left"/> | |||
[[Image:Misplaced-PEG-103.jpg|left|thumb|300px|Misplaced balloon inflation]] | |||
<br clear="left"/> | |||
==Misplaced ventriculoperitoneal shunt catheter == | |||
[http://www.radswiki.net Images courtesy of RadsWiki] | |||
[[Image:Misplaced ventriculoperitoneal shunt001.jpg|left|thumb|300px|A misplaced ventriculoperitoneal shunt catheter]] | |||
<br clear="left"/> | |||
[[Image:Misplaced ventriculoperitoneal shunt002.jpg|left|thumb|300px|A misplaced ventriculoperitoneal shunt catheter]] | |||
<br clear="left"/> | |||
[[Image:Misplaced ventriculoperitoneal shunt003.jpg|left|thumb|300px|A misplaced ventriculoperitoneal shunt catheter]] | |||
<br clear="left"/> | <br clear="left"/> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
==Additional Resources== | |||
* Katz, Douglas S., et al. Radiology Secrets. Hanley & Belfus, INC: 1998. ISBN 1560531584 | |||
[[Category:Medical malpractice]] | |||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
Latest revision as of 17:28, 9 August 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Misplaced nasogastric tube
- What happens if the Nasogastric tube is too high?
- Aspiration
- What happens if the Nasogastric tube is in the trachea or a bronchus?
- Aspiration
- Hypoventilation
- Can intracranial insertion of a Nasogastric tube occur?
- Yes. Especially in trauma patients.
Case #1: Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient with Severe Craniofacial Trauma
- 35 cases of intracranial nasogastric tube insertion have been reported in the international literature. [1] [2]
- A complex craniofacial fracture is the most common predisposing factor.
- Complications include hemiparesis, intracranial bleeding, decerebrate posturing, respiratory arrest, suctioning of brain parenchyma, blindness, loss of the sense of smell, meningitis, decreased mental status, and persistent cerebrospinal fluid fistula.
- Mortality rate of 64%.
Case #2: Nasogastric tube in lung
Misplaced endotracheal tube
- What happens if the endotracheal tube is too high?
- Endotracheal tube can rub against the vocal cords and cause cord trauma.
- What happens if the endotracheal tube is too low?
- Endotracheal tube can selectively intubate the right or left mainstem bronchus.
- Esophagus can also be intubated
- Suspect esophageal intubation when there is progressive gaseous distention of the stomach while the lung volumes remain low.
Misplaced central lines (CVP catheters)
PICC from left superior vena cava to coronary sinus to right atrium to inferior vena cava to left hepatic vein
Coiled in Axillary
Misplaced umbilical venous catheters
UVC through PFO
UVC in SMV
Misplaced Foley catheter
A patient with suprapubic pain after the Foley catheter insertion
Misplaced gastrostomy tube
Misplaced ventriculoperitoneal shunt catheter
References
- ↑ Journal of Oral and Maxillofacial Surgery - http://www.sciencedirect.com/science/journal/02782391
- ↑ Paloma Rodrigues Genú, David Moraes de Oliveira, Ricardo José de Holanda Vasconcellos, Ricardo Viana Bessa Nogueira and Belmiro Cavalcanti do Egito Vasconcelos. Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: A case report. Journal of Oral and Maxillofacial Surgery. 2004. 62: 1435-1438.
Additional Resources
- Katz, Douglas S., et al. Radiology Secrets. Hanley & Belfus, INC: 1998. ISBN 1560531584