Inadvertent tracheobronchial placement of feeding tubes

Seventeen adult patients in whom small-diameter, flexible-tipped feeding tubes had been inadvertently placed in the lung were identified during a 22-month period. In nine patients pneumothorax developed, all cases due to transpleural passage of small-diameter (2.7-mm) feeding tubes. In one of these patients, hydropneumothorax and subsequent empyema developed. Placement of larger diameter (4.3-mm) feeding tubes did not lead to pneumothorax, but pneumonitis developed in one patient after intrapulmonary instillation of antacid solution. Of the 17 patients, 15 had impaired mental status or diminished gag, cough, or swallowing reflexes; the remaining two were pharmacologically sedated during the procedure. Radiographic confirmation of feeding tube placement is essential to avoid these complications, with particular attention paid to the course of the tube.