|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 3 | Page : 111-112
Self-Knotting of a Nasogastric Tube
Luis Rafael Moscote-Salazar1, Eduardo Barciela2, Yan Carlos Ramos3, Loraine Quintana-Pajaro3, Amit Agrawal4
1 Center for Biomedical Research, Research Line Cartagena Neurotrauma Research Group, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Cartagena, Colombia
2 Clinica del Caribe, Barranquilla, Colombia
3 Center for Biomedical Research, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
4 Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
|Date of Submission||25-Jan-2019|
|Date of Acceptance||25-Jun-2019|
|Date of Web Publication||28-Oct-2020|
Dr. Luis Rafael Moscote-Salazar
Center for Biomedical Research, Research Line Cartagena Neurotrauma Research Group, Faculty of Medicine, University of Cartagena, Cartagena de Indias
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Moscote-Salazar LR, Barciela E, Ramos YC, Quintana-Pajaro L, Agrawal A. Self-Knotting of a Nasogastric Tube. J Transl Crit Care Med 2019;1:111-2
Self-knotting of the Ryle's tube is a rare complication associated with Ryle's tube insertion, with only few reported cases.,,,,,,,, We report an unusual case of 86-year-old male who was hospitalized in our intensive care unit on the 1st day with a diagnosis of pneumonia and sequelae of cerebrovascular disease. An intensivist ordered a nasogastric tube to start enteral feeding, and a nurse placed on a Levin 18 F probe. No resistance was found during the placement. When checking its functionality, it was evidenced an obstacle in some point of the probe, and when trying to extract it, it was difficult to remove it. The probe was gently rotated with anesthetic gel applied, by which the extraction of the probe was obtained and a self-node on the tube was observed [Figure 1]. No complications occurred during the procedure, and the pass of the probe was then successful.
Self-knotting of the Ryle's tube can occur either during its insertion or during the removal of the Ryle's tube (with increased risk of knot tightening during removal). A number of risk factors have been recognized which predispose self-knot formation, including excessive length, thin bore tube, altered anatomy (i.e., small stomach), multiple manipulations of the Ryle's tube, neck movements during insertion, chronic cough, softened tube (particularly at body temperature), and endotracheal intubation.,, Clinically, self-knotting can be suspected if there is nonfunctioning of the tube or any difficulty in inserting or removing the Ryle's tube., Removal of the self-knotted tube requires gentle manipulations and pulls to avoid injury mechanical trauma., Removal can be facilitated with Magill's forceps or use of rigid esophagoscopy under direct vision. Such a complication can be best avoided using a larger diameter tube, optimum length, proper lubrication of the distal end, proper placement in the stomach, lateral neck pressure, avoiding excess length in the stomach, and placement of the tube under direct vision.[2-4,6]
|Figure 1: Photograph taken of the knotted tube immediately after removal|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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