Malpositioning of a Nasogastric Tube in the Right Main Bronchus of an Acute Respiratory Failure Patient with an Existing Cuffed Endotracheal Tube

鼻胃管誤放入右支氣管在急性呼吸衰竭併插氣管內管及氣球充起

蕭承愷(Cheng-Kai Shiao) ； 朱國安(Kuo-An Chu) ； 林旻希(Min-Hsi Lin) ； 張慶宏(Chin-Hung Chang) ； 賴瑞生(Ruay-Sheng Lai)

《胸腔醫學》 22卷6期 (2007/12) Pp. 411-415

https://doi.org/10.29806/TM.200712.0006

摘要

鼻胃管置入是在醫療護理過程中常見的臨床程序。不過，鼻胃管的誤置可能引起意想不到的併發症，甚至威脅到生命。我們描述－43歲男性病人進入加護病房，因為在急診室被診斷為左側膿胸併呼吸衰竭，接受插入氣管內管及使用呼吸器和放置鼻胃管。直到三天後我們追蹤的胸部X射線照相才發現鼻胃管誤置進右主支氣管。即使氣管內管的氣囊已打起，並做聽診確認仍將鼻胃管誤放入氣道。幸好，病患當時正在禁食中及做鼻胃管排空引流才未造成併發症。因此，我們認為除了以傳統聽診為鼻胃管確認位置之外，務必常規的胸部X射線照相，以避免不可預期的併發症。

關鍵字

併發症 ； 氣管插管 ； 醫源性 ； 鼻胃管

並列摘要

Nasogastric tube insertion is a common clinical procedure in medical care. However, misplacement of a nasogastric tube can cause unexpected complications which may even be life threatening in some cases. Herein, we describe a 43-year-old man who was admitted to the intensive care unit (ICU) via our emergency department, with the diagnosis of left-side empyema with acute respiratory failure. An endotracheal tube was inserted for mechanical ventilation, and then a nasogastric tube was inserted for decompression. A repeat chest radiograph 3 days later detected the misplacement of the nasogastric tube in the right main bronchus. The misplacement occurred even with the presence of an endotracheal tube with cuff inflation, as well as after confirmation of positioning by auscultation. Therefore, we emphasize the use of routine chest radiography confirmation of nasogastric tube positioning, in addition to conventional methods of auscultation, especially in patients in critical condition or with an existing endotracheal tube and mechanical ventilation.

並列關鍵字

complications ； endotracheal intubation ； iatrogenic ； nasogastric tube