Objective To discuss three cases with complications of oral/nasal feeding tube placement in pediatric patients with endotracheal intubation and mechanical ventilation and review literature on complication rates and placement techniques.
Design Case report and review of the literature.
Patients A 14-year-old male with respiratory distress following a near drowning, a 10-year-old male with recurrent acute lymphocytic leukemia and Pneumocystis carnii pneumonia, and a 16-year-old female with complex congenital heart disease and respiratory failure.
Interventions Placement of oral or nasal feeding tube.
Results Three cases of feeding tube placement errors occurred in our combined medical surgical, 19-bed, tertiary care hospital, pediatric critical care unit within the past year. All three resulted in placement of the feeding tube in the respiratory tree despite the presence of cuffed endotracheal tubes. All three patients had subsequent worsening of their respiratory status. One patient developed a pneumothorax, one patient developed pulmonary hemorrhage, and the other had an increased oxygen requirement.
Conclusions Patients are at risk for misplacement of oral or nasal feeding tubes even when intubated with a cuffed endotracheal tube, which was previously felt to be a protective factor. Errors in the placement of feeding tubes may cause serious morbidity and mortality. Checking placement of feeding tubes with methods described in the literature may not be sufficient, and radiographic confirmation of placement is needed.
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