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 â€˜congenital anomalyâ€™ 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, evenÂ with our â€˜routineâ€™ procedures.
You just do not want to see a CT scan like that on your shift.
- 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 [↩]