0
selected
-
1.
Administering Polyethylene Glycol Electrolyte Solution Via a Nasogastric Tube: Pulmonary Complications.
Metheny, NA, Meert, KL
American journal of critical care : an official publication, American Association of Critical-Care Nurses. 2017;(2):e11-e17
Abstract
BACKGROUND Patients sometimes require insertion of a nasogastric tube for the administration of a large volume of a polyethylene glycol electrolyte solution. If the tube is malpositioned, the risk for direct instillation of the solution into the lung increases. The risk for aspiration also increases if the infusion rate exceeds gastrointestinal tolerance. PURPOSE To review published cases of patients' experiencing adverse pulmonary events after administration of polyethylene glycol electrolyte solution via a nasogastric tube and to offer suggestions to prevent these outcomes. METHODS A search of the literature from 1993 through 2014 was performed by using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases. RESULTS In the 12 case reports located, none of the patients had radiographs to verify tube location before infusion of polyethylene glycol electrolyte solution. After symptoms developed in 3 children (ages 8-11 years), radiographs showed their tubes incorrectly positioned in the bronchus, lung, or esophagus; ports of a fourth child's tube were in the oropharynx. The remaining 8 patients (ages 5-86 years) never had radiographs to determine tube placement. Pulmonary complications from the infusions of polyethylene glycol electrolyte solution contributed to the death of 5 of the patients. CONCLUSION Relatively simple maneuvers to reduce the likelihood of adverse pulmonary events following the administration of large volumes of polyethylene glycol electrolyte solution via a nasogastric tube are well worth the cost and effort to protect patients from potential serious injury.
-
2.
One-step percutaneous gastrojejunostomy in early infancy.
Michaud, L, Robert-Dehault, A, Coopman, S, Guimber, D, Turck, D, Gottrand, F
Journal of pediatric gastroenterology and nutrition. 2012;(6):820-1
Abstract
In certain conditions that obviate the use of gastric feedings, the insertion of a jejunal feeding tube via gastrostomy constitutes an alternative to jejunostomy but requires a preexisting gastrostomy. Our aim was to assess a new technique of 1-step gastrojejunal tube insertion through a de novo gastrostomy. A total of 3 infants between 3 and 7 months old and weighing between 4.1 and 5.4 kg had a gastrojejunal feeding tube inserted using a 16-CH French introducer percutaneous endoscopic gastrostomy kit and a transgastric-jejunal feeding tube. No technical difficulties occurred and the gastrojejunal feeding tube was placed successfully in the 3 patients, the total procedure lasting 15 to 20 minutes. Enteral feeding was started within 4 to 6 hours of the procedure. Neither immediate (<24 hours) nor late complications related to the gastrojejunostomy occurred. Nissen fundoplication was performed in 2 of our patients at 12 and 15 months of age, respectively. The gastrojejunostomy tube was still in place in the third patient at age 15 months. Our first experience suggests that 1-step endoscopic placement of a transgastric-jejunal feeding tube without a preexisting gastrostomy tract is feasible in young and low-weight infants.
-
3.
Replacement gastrostomy tube causing acute pancreatitis: case series with review of literature.
Shah, AM, Shah, N, DePasquale, JR
JOP : Journal of the pancreas. 2012;(1):54-7
Abstract
CONTEXT Percutaneous endoscopic gastrostomy (PEG) feedings are generally considered safe with few serious complications. Acute pancreatitis is a rare complication associated with replacement percutaneous endoscopic gastrostomy tubes. CASE REPORT We report two cases of acute pancreatitis induced by migrated replacement percutaneous endoscopic gastrostomy tubes. CONCLUSIONS Migration of a balloon into the duodenum can result in external manipulation of the ampulla of Vater thereby disturbing the flow of pancreatic secretions leading to acute pancreatitis. Recognition of this complication is important and should be included as potential etiology of acute pancreatitis in patients receiving percutaneous endoscopic gastrostomy feedings. Periodic examination and documentation of the distance of the balloon from the skin should be performed to document the position of the tubes or any inadvertent migration of the tubes. The use of Foley catheters as permanent replacement tubes should be considered medically inappropriate.
-
4.
Metastasis of untreated head and neck cancer to percutaneous gastrostomy tube exit sites.
Sheykholeslami, K, Thomas, J, Chhabra, N, Trang, T, Rezaee, R
American journal of otolaryngology. 2012;(6):774-8
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head and neck tumors. PEG tube placement is considered safe and complications are infrequent. METHODS A comprehensive review of the literature in MEDLINE (1962-2011) was performed. We report herein 3 new cases. RESULTS The literature search revealed 43 previous cases. The interval between PEG placement and diagnosis of metastasis ranged from 1 to 24 months. CONCLUSIONS Metastatic cancer should be considered in patients with head and neck cancer that have persistent, unexplained skin changes at PEG site, anemia, or guaiac positive stools without a clear etiology. The direct implantation of tumor cells through instrumentation is the most likely explanation, although hematogenous and/or lymphatic seeding is also a possibility. Our review of the literature and clinical experience indicate that the "pull" technique of PEG placement may directly implant tumor cells at the gastrostomy site.
-
5.
Esophageal bezoar formation due to solidification of enteral feed administered through a malpositioned nasogastric tube: case report and review of the literature.
Tawfic, QA, Bhakta, P, Date, RR, Sharma, PK
Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 2012;(4):188-90
Abstract
Enteral feeding is now standard and routine practice in intensive care. The use of a nasogastric tube for enteral feeding is generally considered to be safe, but tubes with small bores can sometimes lead to aspiration or passage clogging when malpositioned in sedated patients who are on long-term mechanical ventilation. Thus, accurate confirmation of correct placement is mandatory in such patients. This is not always the case, but this faulty practice can lead to serious complications in the absence of potential bezoar-forming medicines or gastrointestinal pathology. We present here one such interesting case of a patient who developed esophageal bezoar due to a malpositioned nasogastric tube for administering a casein-containing feed. In addition, we present a review of the literature.
-
6.
Iatrogenic traumas by nasogastric tube in very premature infants: our cases and literature review.
Gasparella, M, Schiavon, G, Bordignon, L, Buffo, M, Benetton, C, Zanatta, C, Ferro, M, Zoppellaro, F, Perrino, G
La Pediatria medica e chirurgica : Medical and surgical pediatrics. 2011;(2):85-8
Abstract
OBJECTIVE The nasogastric tube is the chosen nutritional technique in premature infants. However, it is not without complications. The aim of this study is to compare our experience in iatrogenic complications caused by nasogastric tube (especially in very low birth weight infants) to a review of the most recent literature. METHODS From january to december of 2008, in the Department of Neonatal Pathology at the Hospital of Treviso, 118 premature patients were treated. 110 of them had a body weight less than 1,500gr: serious complications caused by nasogastric tube occurred in two of these very low birth weight infants. The first case relates an injury of the esophagus, while the second case is about a perforation of the posterior wall of the stomach, left lobe of the liver and the spleen hilus. RESULTS The surgical treatment was limited to the second case ending in splenectomy and repair of the posterior gastric wall and liver lobe. DISCUSSION AND CONCLUSIONS Among all the iatrogenic injuries described in the literature, this last case is the most serious. It is important to verify always the position of the gastric tube and to doubt for a dislocation in any case of deviation of the tube from the normal course. In those cases in which a patient suddenly goes from a full well-being to a critical state without a precise contingent cause it is imperative to check the nasogastric tube place. In addition those cases have guided us to change our habits for managing these critical patients: we are then oriented toward the usage of silastic gastric probes, which are softer, less dangerous for ulcer damages, and long term replaceable, thus reducing the possibility of a iatrogenic injury.
-
7.
Implantation of oral squamous cell carcinoma at the site of a percutaneous endoscopic gastrostomy: a case report.
Ananth, S, Amin, M
The British journal of oral & maxillofacial surgery. 2002;(2):125-30
Abstract
A 55-year-old man had an operation and radiotherapy for a squamous cell carcinoma of the oral cavity and developed a metastatic deposit at the site of a percutaneous endoscopic gastrostomy, with no other evidence of systemic spread. Treatment of the metastasis was by neo-adjuvant chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by en bloc resection of the stomal recurrence on the anterior abdominal wall. There has been no evidence of recurrence to date. Only 17 other cases of metastasis to this site from a primary tumour in the upper aerodigestive tract have been reported. We review the relevant publications and discuss the techniques, complications and possible mechanisms of spread and their implications for the use of percutaneous endoscopic gastrostomy in head and neck cancer surgery.