A review of published case reports of inadvertent pulmonary placement of nasogastric tubes in children.
OBJECTIVE
Little is known about the incidence of inadvertent pulmonary placement of nasogastric tubes during blind insertions in children.


OBJECTIVE
The purpose of this paper was to conduct a review of published case reports over the past two decades.


METHODS
An OVID Medline search was conducted of articles published from 1993 through 2012.


RESULTS
Fifteen published case reports were located; four patients died as a result of their malpositioned tubes. The auscultatory bedside method failed to detect the malpositioned tubes in all seven cases in which it was used.


CONCLUSIONS
The incidence of inadvertent pulmonary placement of nasogastric tubes is relatively low but can lead to serious and even lethal results in children. The auscultatory method to predict tube location is unreliable.
Saint Louis University School of Nursing, St. Louis, MO. Electronic address: methenna@slu.edu.
Norma A
NA
Metheny
Department of Pediatrics Children's Hospital of Michigan, Wayne State University, Detroit, MI.
Kathleen L
KL
Meert
D002648:Child; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008168:Lung; D019300:Medical Errors
Adolescent; Charcoal; Child; Diagnostic errors; Enteral Nutrition; Gastrointestinal intubation; Infant; Intratracheal intubation; Medical errors; Newborn; Pneumothorax