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Iatrogenic Injury: Feeding Tubes
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Patient injury caused by improper feeding tube placement
          • Feeding tubes
            • Small, soft enteric tubes
            • Some with flexible metallic tips
            • Used for feeding chronically ill patients
            • Can be used for long periods of time
          • Nasogastric tubes
            • Large-bore, moderately stiff
            • Used for temporary bowel decompression or fluid sampling
            • Tip placed in pylorus can cause gastric outlet obstruction
          • Gastrostomy and jejunostomy tubes
            • Placed surgically, endoscopically, or percutaneously
            • Used for long-term, possibly permanent, feeding
            • Use imaging to visualize tube balloon, surgical clips, and cuff
              • Cuff initiates soft tissue reaction to anchor tube to abdominal wall
            • Percutaneous endoscopic gastrostomy (PEG) button can replace tube several weeks post placement
              • Placed in anterior abdominal wall
            • Balloon-tipped catheters should not be placed into small bowel
              • Likely to obstruct bowel lumen

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              CLINICAL ISSUES

              • Presentation

                • Demographics

                  • Treatment

                    DIAGNOSTIC CHECKLIST

                    • Consider

                      Selected References

                      1. McCutcheon KP et al: Feeding tube insertion and placement confirmation using electromagnetic guidance: a team review. JPEN J Parenter Enteral Nutr. 42(1):247-54, 2018
                      2. Winder JS et al: Multimodal endoscopic management of iatrogenic transverse colon injuries from a percutaneous endoscopic gastrostomy tube. Gastrointest Endosc. 83(6):1290-1, 2016
                      3. Ojo O: Problems with use of a Foley catheter in enteral tube feeding. Br J Nurs. 23(7):360-2, 364, 2014
                      4. Gor P: Placement of nasogastric tubes must be checked thoroughly. Nurs Stand. 27(43):32, 2013
                      5. Khasawneh FA et al: Nasopharyngeal perforation by a new electromagnetically visualised enteral feeding tube. BMJ Case Rep. 2013, 2013
                      6. Marco J et al: Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments. Rev Clin Esp (Barc). 213(5):223-8, 2013
                      7. Simons SR et al: Bedside assessment of enteral tube placement: aligning practice with evidence. Am J Nurs. 112(2):40-6; quiz 48, 47, 2012
                      8. de Aguilar-Nascimento JE et al: Use of small-bore feeding tubes: successes and failures. Curr Opin Clin Nutr Metab Care. 10(3):291-6, 2007
                      9. Hunter TB et al: Medical devices of the abdomen and pelvis. Radiographics. 25(2):503-23, 2005
                      10. Swain FR et al: Traumatic complications from placement of thoracic catheters and tubes. Emerg Radiol. 12(1-2):11-8, 2005
                      11. Faries MB et al: Use of gastrostomy and combined gastrojejunostomy tubes for enteral feeding. World J Surg. 23(6):603-7, 1999
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Clinical Issues

                            TERMINOLOGY

                            • Definitions

                              • Patient injury caused by improper feeding tube placement
                              • Feeding tubes
                                • Small, soft enteric tubes
                                • Some with flexible metallic tips
                                • Used for feeding chronically ill patients
                                • Can be used for long periods of time
                              • Nasogastric tubes
                                • Large-bore, moderately stiff
                                • Used for temporary bowel decompression or fluid sampling
                                • Tip placed in pylorus can cause gastric outlet obstruction
                              • Gastrostomy and jejunostomy tubes
                                • Placed surgically, endoscopically, or percutaneously
                                • Used for long-term, possibly permanent, feeding
                                • Use imaging to visualize tube balloon, surgical clips, and cuff
                                  • Cuff initiates soft tissue reaction to anchor tube to abdominal wall
                                • Percutaneous endoscopic gastrostomy (PEG) button can replace tube several weeks post placement
                                  • Placed in anterior abdominal wall
                                • Balloon-tipped catheters should not be placed into small bowel
                                  • Likely to obstruct bowel lumen

                            IMAGING

                            • General Features

                              • Imaging Recommendations

                                • Radiographic Findings

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. McCutcheon KP et al: Feeding tube insertion and placement confirmation using electromagnetic guidance: a team review. JPEN J Parenter Enteral Nutr. 42(1):247-54, 2018
                                          2. Winder JS et al: Multimodal endoscopic management of iatrogenic transverse colon injuries from a percutaneous endoscopic gastrostomy tube. Gastrointest Endosc. 83(6):1290-1, 2016
                                          3. Ojo O: Problems with use of a Foley catheter in enteral tube feeding. Br J Nurs. 23(7):360-2, 364, 2014
                                          4. Gor P: Placement of nasogastric tubes must be checked thoroughly. Nurs Stand. 27(43):32, 2013
                                          5. Khasawneh FA et al: Nasopharyngeal perforation by a new electromagnetically visualised enteral feeding tube. BMJ Case Rep. 2013, 2013
                                          6. Marco J et al: Bronchopulmonary complications associated to enteral nutrition devices in patients admitted to internal medicine departments. Rev Clin Esp (Barc). 213(5):223-8, 2013
                                          7. Simons SR et al: Bedside assessment of enteral tube placement: aligning practice with evidence. Am J Nurs. 112(2):40-6; quiz 48, 47, 2012
                                          8. de Aguilar-Nascimento JE et al: Use of small-bore feeding tubes: successes and failures. Curr Opin Clin Nutr Metab Care. 10(3):291-6, 2007
                                          9. Hunter TB et al: Medical devices of the abdomen and pelvis. Radiographics. 25(2):503-23, 2005
                                          10. Swain FR et al: Traumatic complications from placement of thoracic catheters and tubes. Emerg Radiol. 12(1-2):11-8, 2005
                                          11. Faries MB et al: Use of gastrostomy and combined gastrojejunostomy tubes for enteral feeding. World J Surg. 23(6):603-7, 1999