Marderstein et al identified risk factors for pneumothorax after placement of a nasoenteric feeding tube in critically ill patients. Special care should be taken when any of these risk factors are present. The authors are from the University of Pittsburgh.


Pathogenesis of pneumothorax:

(1) Nasoenteric feeding tubes have a metal stylet and a tungsten-weight tip which aid in tube tip placement.

(2) A pneumothorax may develop if the tube is introduced into the trachea and threaded through a distal bronchus.


Patient-related risk factors:

(1) absent gag reflex

(2) patient with a history of previous feeding tube misplacements into the airway

(3) presence of an endotracheal tube or tracheostomy


Risk factors associated with the insertion:

(1) inexperienced inserter

(2) hurried insertion

(3) insertion at night

(4) failure to confirm placement with an X-ray after partial placement (The authors confirmed esophageal placement after advancing the tip to 35 cm).


Restricting feeding tube placement to a specialized insertion team can significantly reduce complications. However, many problems can be prevented by simple controls.


Additional complications may occur if the misplacement is not recognized and feeding solution is infused.


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