Misplaced catheter

Associate Editor-In-Chief:

Misplaced nasogastric tube

 * What happens if the Nasogastric tube is too high?
 * Aspiration
 * What happens if the Nasogastric tube is in the trachea or a bronchus?
 * Aspiration
 * Hypoventilation
 * Can intracranial insertion of a Nasogastric tube occur?
 * Yes. Especially in trauma patients.

Case #1: Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient with Severe Craniofacial Trauma

 * 35 cases of intracranial nasogastric tube insertion have been reported in the international literature.
 * A complex craniofacial fracture is the most common predisposing factor.
 * Complications include hemiparesis, intracranial bleeding, decerebrate posturing, respiratory arrest, suctioning of brain parenchyma, blindness, loss of the sense of smell, meningitis, decreased mental status, and persistent cerebrospinal fluid fistula.
 * Mortality rate of 64%.

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Case #2: Nasogastric tube in lung




Misplaced endotracheal tube

 * What happens if the endotracheal tube is too high?
 * Endotracheal tube can rub against the vocal cords and cause cord trauma.
 * What happens if the endotracheal tube is too low?
 * Endotracheal tube can selectively intubate the right or left mainstem bronchus.
 * Esophagus can also be intubated
 * Suspect esophageal intubation when there is progressive gaseous distention of the stomach while the lung volumes remain low.

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PICC from left superior vena cava to coronary sinus to right atrium to inferior vena cava to left hepatic vein
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Coiled in Axillary
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UVC through PFO
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UVC in SMV
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A patient with suprapubic pain after the Foley catheter insertion
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Misplaced gastrostomy tube
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Misplaced ventriculoperitoneal shunt catheter
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Additional Resources

 * Katz, Douglas S., et al. Radiology Secrets. Hanley & Belfus, INC: 1998. ISBN 1560531584