Presentation
Unwell ICU patient. Insertion of multiple tubes and support lines.
Patient Data
The weighted tip of the right nasogastric tube projects over the lower zone of the right lung, its course following the right main bronchus and lower lobe segmental bronchi.
The tip of the endotracheal tube projects approximately 4 cm above the carina in appropriate position. A three lead cardiac device is in situ, leads projected over the cardiac silhouette. Midline sternotomy wires related to prior cardiac surgery noted.
The lungs appear congested even allowing for the supine examination. Mild peripheral interlobular septal thickening (?related to interstitial pulmonary edema).
Case Discussion
This is a case of a misplaced nasogastric tube, which needs to be urgently re-sited. Feeding through a nasogastric tube situated in the airway will cause significant morbidity, and potentially death.
The weighted tip of the nasogastric tube should project below the left hemi-diaphragm - a minimum of 5-10 cm beyond the gastro-esophageal junction. Any side holes should also be positioned distal to the gastro-esophageal junction.
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