Misplaced catheter

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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%.

Images courtesy of RadsWiki

Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient With Severe Craniofacial Trauma

Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient With Severe Craniofacial Trauma

Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient With Severe Craniofacial Trauma

Inadvertent Intracranial Placement of a Nasogastric Tube in a Patient With Severe Craniofacial Trauma

Case #2: Nasogastric tube in lung

Nasogastric tube in right lung

Nasogastric tube in right 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.

Images courtesy of RadsWiki

No left breath sounds post intubation: ETT in right mainstem bronchus

ETT pulled back and now in good position

Esophageal intubation

Misplaced central lines (CVP catheters)

PICC from left superior vena cava to coronary sinus to right atrium to inferior vena cava to left hepatic vein

Image courtesy of RadsWiki

Coiled in Axillary

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Misplaced umbilical venous catheters

UVC through PFO

Image courtesy of RadsWiki

UVC in SMV

Image courtesy of RadsWiki

Misplaced Foley catheter

A patient with suprapubic pain after the Foley catheter insertion

Images courtesy of RadsWiki

Misplaced Foley catheter (The catheter placed into patients uterus)

Misplaced Foley catheter (The catheter placed into patients uterus)

Misplaced gastrostomy tube

Images courtesy of RadsWiki

A gastrostomy tube in the liver

A gastrostomy tube in the liver

A gastrostomy tube in the liver

Misplaced balloon inflation

Misplaced balloon inflation

Misplaced ventriculoperitoneal shunt catheter

Images courtesy of RadsWiki

A misplaced ventriculoperitoneal shunt catheter

A misplaced ventriculoperitoneal shunt catheter

A misplaced ventriculoperitoneal shunt catheter

Additional Resources

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