The insertion of nasogastric (NG) tubes is pretty common these days.

Most nurses have inserted them, and those that have had any experience with the management of trauma patients, know that attempting to insert a NG tube into a patient with a potential base of skull fracture is contraindicated due to the risk of the tube entering the cranium via a fractured cribriform plate1.

However, here is something that is a little disturbing.

From the British Medical Journal comes a 1996 report on a NG tube that was accidentally passed into the brain of 59 yo female patient who had no history of trauma.
The lady ( a poorly controlled epileptic) presented with a 6 hour history of seizures following a prodrome of several hours vomiting.
The seizures were terminated following IV diazepam on arrival at the ED.

To decrease the risk of aspiration, the staff then attempted to insert a NG tube:

Three attempts at insertion were made,each of them producing blood stained fluid. When the fluid was aspirated and tested using litmus paper there was no colour change.
The tube was left in position after the third insertion as the fluid was assumed to be blood stained nasal secretions resulting from traumatic intubation.
Although the resuscitation was successful in terminating the fit, the patient remained deeply unconscious.
In view of this, and the past history of meningitis, computerised tomography was undertaken.

The patient subsequently had the tube surgically removed… but eventually died from an overwhelming sepsis.
Postmortem examination identified a small defect, a ‘congenital anomaly’ known as a nasal glioma just lateral to the cribriform plate.

This is an extremely rare occurrence, with only one or two cases ever documented.
But things like this serve to remind us never to get too complacent, even  with our ‘routine’ procedures.

You just do not want to see a CT scan like that on your shift.

Reference: Inadvertent intracranial insertion of a nasogastric tube in a non-trauma patient (BMJ)

  1. The cribriform plate is a sieve-like region of the ethmoid bone (which separates the nasal cavity from the brain). When base of skull fractures are suspected an oro-gastric tube is placed instead []

15 Responses to “NG tube into brain.”

  1. thats why x ray is needed to verify placement :)

  2. Yes Mary i agree, nurse’s these days are needing to be the same standard as a junior DR, the differences’ only being that we’re less arrogant and actually care about the patient. Doc-Oc, perhaps if you were a bit more humble and actually realised that the nurse has a lot to give to support you (and vice versa) then you will perhaps be a little more respected.
    Change your attitude!!!

  3. Doc_Oc, yep, you got us. We are all just itching to call doctors every minute of the day.*insert eye roll* I really wish doctors would dot their i’s, cross their t’s, get their drug orders properly written up, write legibly and have their plan for the patients care in place so I didn’t have to waste my time calling them.

  4. This is just another reason for nurses to call the doctor every other minute. ” Hello Dr. can you please see Mr Smith CT and make sure the NGT is not in his brain!”

    • Gee, you seem like a pleasant guy who enjoys life, respects his colleagues and in turn is respected. Or, maybe not. Work on the attitude until you get the actual GOD designation.

  5. Wow, I don’t know how many NG tubes I have inserted, this was not ever a consideration before, one more thing to worry about.

  6. This something I have always feared, but was assured it could not happen. This is so scary.

  7. Wow – that is NASTY-looking…

    I learned how to place NG tubes when I was in Paramedic school. It is a skill that, while rarely used, is sometimes called for in our pre-hospital protocols. It’s not difficult to perform. It’s also not difficult to perform incorrectly, as evidenced by the above CT films…

  8. Back when I learned the basics of NG tube insertion, the professor did mention this risk and showed us the x-rays – to make sure we’d never forget to aspirate and auscultate after placing an NG tube, I imagine. Forgetting to check the proper location of the tube is an instant fail at the exam too.

    Then again, the hospital had experienced a similar case a few years back, with a small child, and everyone was still pretty shaken up about it, so maybe that’s why our professor made such a big deal out of it. It still makes me nauseous to think about. :(

  9. why was it left in place if whoever was putting it KNEW it was in the wrong place due to a bloody aspirate? even if it was curled in the nasopharynx should have been removed.

    And where was the confirming xray if it was left in place???

    very unfortunate rare occurrence, but poor form none the less

  10. [...] go read ImpactedNurse‘s post. And [...]

  11. That is f***ing freaky! Good point about not getting complacent, though I haven’t done enough of these yet to get complacent any time soon. Brad, this is not routinely taught since it’s a one-in-a-million chance it will happen. It’s due to a congenital anomaly and like it says in the post, there are only a couple cases ever documented of it happening.

    This might be a dumb question, but a NGT is properly inserted can you shine a light down the back of the throat and see it? I know we often see it coming out the mouth or curling at the back of the throat when it’s going down the wrong way, but never thought to check if was visible once it was down.

  12. I agree with Brad – nothing was mentioned about the gag reflex etc….and the youtube pictures all made it look so easy

  13. Just last week I learned the basic on NG tube insertion….they didn’t mention this!

  14. That’s the scariest thing I have ever seen.

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