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LETTER TO EDITOR
Year : 2015  |  Volume : 59  |  Issue : 5  |  Page : 331-332  

Self-knotting of a nasogastric tube passed through i-gel™


Department of Anesthesiology, Saket City Hospital, New Delhi, India

Date of Web Publication12-May-2015

Correspondence Address:
Dr. Mukul Chandra Kapoor
Department of Anesthesiology, Saket City Hospital, 6, Dayanand Vihar, New Delhi - 110 092
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.156902

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How to cite this article:
Garg S, Kapoor MC. Self-knotting of a nasogastric tube passed through i-gel™. Indian J Anaesth 2015;59:331-2

How to cite this URL:
Garg S, Kapoor MC. Self-knotting of a nasogastric tube passed through i-gel™. Indian J Anaesth [serial online] 2015 [cited 2020 Dec 2];59:331-2. Available from: https://www.ijaweb.org/text.asp?2015/59/5/331/156902

Sir,

A 55 kg, 35-year-old lady, was anaesthetised for laparoscopic cholecystectomy. A no. 3 i-gel (Intersurgical Ltd., Wokingham, Berkshire, UK) supraglottic airway device was used to maintain airway and a 12FG nasogastric tube (NGT) (Romsons, Agra, Uttar Pradesh, India) passed through its gastric channel, for decompression of the stomach, in one attempt without encountering any resistance. On completion of the surgery, the NGT could not be pulled out of the channel. The i-gel and the NGT were removed en masse. The NGT was found to have a lariat loop knot at its gastric end [Figure 1].
Figure 1: Knotted gastric end of the nasogastric tube removed along with the i-gel™

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i-gel is a supraglottic airway device made of medical grade thermoplastic elastomer, which has an integrated gastric channel to facilitate venting of stomach gas and allowing passage of NGT to empty the stomach contents. Although there are reports of self-knotting of NGT, [1] there are no reports of such an occurrence in NGT passed through i-gel , possibly because its channel prevents the bending of the NGT and facilitates its entry into the oesophagus.

The incidence of self-knotting of NGT appears to be low. [1] Risk factors include smaller diameter NGT, insertion deep into the stomach, and repetitive advancement of the NGT, pushing or pulling of NGT after it has been placed and interference with an endotracheal tube in the intubated patient. [2],[3],[4],[5] The diameter of the NGT in the case was small due to restrictions of the i-gel channel dimension. Once knotted, the traction during retrieval tightens the knot. [1] NGTs are generally made up of polyvinyl chloride, which tends to soften when exposed to body temperature. The soft tubes tend to roll up and this may promote knot formation. Mechanism of knot formation is similar to that of supercoiling. Knotting of NGT during both insertion and removal can lead to serious complications, which include respiratory distress, [5] severe laryngeal injury, [5] and tracheoesophageal puncture, [6] in both intubated and non-intubated patients.

Knotting of NGT can be prevented by using large bore tubes, avoiding repeated insertion attempts, using NGT made of stiffer material and avoiding NGT insertion deeper than that optimum for that size.

 
   References Top

1.
Dasani B, Sahdev P. Knotting of a nasogastric tube: A case report. Am J Emerg Med 1991;9:565.  Back to cited text no. 1
    
2.
Mandal NG, Foxell R. Knotting of a nasogastric tube. Anaesthesia 2000;55:99.  Back to cited text no. 2
    
3.
Dinsmore RC, Benson JF. Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx. South Med J 1999;92:1005-7.  Back to cited text no. 3
    
4.
Santhanam V, Margarson M. Removal of self-knotted nasogastric tube: Technical note. Int J Oral Maxillofac Surg 2008;37:384-5.  Back to cited text no. 4
    
5.
Agarwal A, Gaur A, Sahu D, Singh PK, Pandey CK. Nasogastric tube knotting over the epiglottis: A cause of respiratory distress. Anesth Analg 2002;94:1659-60.  Back to cited text no. 5
    
6.
Malik NW, Timon CI, Russel J. A unique complication of primary tracheoesophageal puncture: Knotting of the nasogastric tube. Otolaryngol Head Neck Surg 1999;120:528-9.  Back to cited text no. 6
    


    Figures

  [Figure 1]


This article has been cited by
1 Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature
Michael Long,Melissa Machan,Luis Tollinche
Open Journal of Anesthesiology. 2017; 07(03): 43
[Pubmed] | [DOI]



 

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