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| LETTER TO THE EDITOR |
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| Year : 2019 | Volume
: 1
| Issue : 3 | Page : 111-112 |
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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 |
Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Center for Biomedical Research, Research Line Cartagena Neurotrauma Research Group, Faculty of Medicine, University of Cartagena, Cartagena de Indias
Colombia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jtccm.jtccm_4_19
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 |
Dear Editor,
Self-knotting of the Ryle's tube is a rare complication associated with Ryle's tube insertion, with only few reported cases.[1],[2],[3],[4],[5],[6],[7],[8],[9] 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[1] or during the removal of the Ryle's tube (with increased risk of knot tightening during removal).[3] 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,[3] softened tube (particularly at body temperature),[2] and endotracheal intubation.[2],[10],[11] Clinically, self-knotting can be suspected if there is nonfunctioning of the tube[4] or any difficulty in inserting or removing the Ryle's tube.[12],[13] Removal of the self-knotted tube requires gentle manipulations and pulls to avoid injury mechanical trauma.[4],[14] Removal can be facilitated with Magill's forceps[10] or use of rigid esophagoscopy under direct vision.[15] 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
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Kinshuck AJ, William CE, Reddy CE. A forgotten nasogastric tube. Clin Rhinol 2011;4:43-6.  |
| 2. | Santhanam V, Margarson M. Removal of self-knotted nasogastric tube: Technical note. Int J Oral Maxillofac Surg 2008;37:384-5. |
| 3. | Wright S, Warusavitarne J, Shaikh I. Safe removal of knotted nasogastric tubes. Nurs Times 2014;110:16-7. |
| 4. | Onotai OL, Uyanwanne NS. Self-knotting of nasogastric tube: Case report and review of literature. Br J Med Med Res 2015;9:1-5. |
| 5. | Dasani B, Sahdev P. Knotting of a nasogastric tube: A case report. Am J Emerg Med 1991;9:565. |
| 6. | Egan DJ, Shami N. Self-knotting of a nasogastric tube. West J Emerg Med 2011;12:266-7. |
| 7. | Abbas GA, Tawfeeq MA, Arain ZB. Nasogastric tube self-knotting. Ann Pediatr Surg 2016;12:162-3. |
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| 10. | Awe J. Self knotting of nasogastric tube: An unusual and rare complication. Global Adv Res J Microbiol 2014;3:64-7. |
| 11. | Dinsmore RC, Benson JF. Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx. South Med J 1999;92:1005-7. |
| 12. | Narayan K, Gupta G, Nijhawan S, Puri S. Unique removal of a kinked nasogastric tube. J Dig Endosc 2017;8:97-9. [Full text] |
| 13. | Jha RT, Potdar M. Knotted Ryle's tube: A rare complication. Res Inno Anesth 2017;2:71-2. |
| 14. | Ongom P, Nassali G, Kaggwa S, Nakavuma L. Nasogastric tube knotting: Two case reports from Kampala, Uganda. East Cent Afr J Surg 2012;17:106-9. |
| 15. | Mohsin M, Saleem Mir I, Hanief Beg M, Nazir Shah N, Arjumand Farooq S, Altaf Bachh A, et al. Nasogastric tube knotting with tracheoesophageal fistula – A rare association. Interact Cardiovasc Thorac Surg 2007;6:508-10. |
[Figure 1]
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