INADVERTENT PLACEMENT OF NASOGASTRIC TUBE IN TRACHEA IN INTUBATED PATIENT AND ROLE OF CAPNOGRAM IN DETECTING THE SAME : A CASE REPORT

Abstract

Nasogastric tube insertion is a simple procedure and it is commonly inserted in intubated patients for early initiation of enteral nutrition in post-operative period. However its insertion in an intubated, paralysed and sedated patient may be difficult. Serious complications such as pneumothorax, plueral effusion and even death can result if nasogastric tube is misplaced and is inadvertently placed in trachea and lungs. We share our experience of  having with us a 50 years adult achondroplasic male with restricted mouth opening who got operated for buccal mucosa carcinoma under general anaesthesia with fibreoptic intubation ( patient underwent Commando surgery) and was shifted to intensive care unit (ICU) for elective ventilation and observation purpose in view of difficult intubation and prolonged duration of surgery. A 14 French feeding tube was inserted on post- operative day 2 in ICU with minimal resistance. Auscultation of epigastrium for air was inconclusive. Direct laryngoscopy was not feasible due to restricted mouth opening and xray machine was not readily available. But capnogram on monitor was getting depressed which helped us in knowing it could be  intratracheal placement of NGT rather than esophageal. Intratracheal placement was further confirmed by Ultrasonography as well. And NGT was instantly removed. Therefore, hereby, we are emphasizing on the role of capnogram for early detection of intratracheal placement of NGT in similar patients while inserting it.