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Clinical Note |

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

Jamie O. Lo, MD; Vivian Wu, MD; Douglas Reh, MD; Shri Nadig, MD; Mark K. Wax, MD
Arch Otolaryngol Head Neck Surg. 2008;134(5):547-550. doi:10.1001/archotol.134.5.547.
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A significant 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.

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Figure 1.

Chest radiographs showing feeding tube placement, hospital day 4 (A), and large left pleural effusion and pneumothorax with the Dobhoff feeding tube in the left main bronchus and left diaphragmatic sulcus of the pleural space, hospital day 5 (B).

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Figure 2.

Chest radiographs showing placement of the Dobhoff feeding tube into the stomach (A [arrow indicates angle of entry]) and into the left main bronchus (B).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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