2006 Volume 26 Issue 7 Pages 730-733
Inadvertent tracheobronchial intubation of a nasogastric tube sometimes occurs and it may cause several complications including pneumothorax, pneumonia, pulmonary hemorrhage and bronchopleural fistula. We experienced a case of intrabronchial malpositioning of a nasogastric tube in a 79-year-old patient who was scheduled to undergo coronary artery bypass graft surgery (CABG) . The nasogastric tube was inserted after completion of CABG because of concerns about the nasal bleeding caused by the intraoperative use of heparin. No change in waveform of the capnogram was observed during the insertion, but gastric juice was not obtained by sucking on the tube. Inadvertent tube placement was not suspected, and the patient was transferred to the intensive care unit. Nasogastric tube malpositioning in the right bronchus was confirmed by chest radiography. There were no complications caused by bronchial placement of the nasogastric tube. Radiographic detection is an effective method of assuring accurate nasogastric tube placement, but observation of the waveform of the capnogram may not be. After this incident, we created an insertion manual for nasogastric tubes in an attempt to verify proper placement.
