Removal of Knotted Nasogastric Tube: A Literature Review and Lessons From Our Case

Abstract

Nasogastric tube placement is a common practice, and complications are rarely reported. We recently encountered and successfully managed a knotted nasogastric tube in a chronically bedridden patient. His nasal and nasopharyngeal mucosa were exceptionally dry, and the tube was not well advanced. The attending physician had difficulty removing the tube, and unsuccessful removal attempts resulted in the patient experiencing epistaxis and respiratory discomfort. Imaging and endoscopic evaluation revealed that the tube was knotted at the choanal level, obstructing the posterior airway. We cut the tube within the middle nasal cavity and removed the knotted part through the mouth; the remaining parts of the tube were removed through the nasal cavity. Herein, we describe our case and other previously reported cases of nasogastric tube knotting to guide healthcare workers who may encounter similar scenarios.