Differential diagnosis of pediatric neurally adjusted ventilatory assist catheter malfunction

• Initial malposition or subsequent migration of NAVA catheter tip into the esophagus
• Initial malposition or migration of NAVA catheter tip into trachea or mainstem bronchus
• Perforation of the esophagus during placement of NAVA catheter

Approach to the differential diagnosis of Neurally Adjusted Ventilatory Assist (NAVA) catheter malfunction:

• The correct position for a NAVA catheter tip is in the body of the stomach, otherwise tip is malpositioned
• Placement of the NAVA catheter tip into the airway or lung or pleural space can result in pneumothorax
• Pnemopericardium, pneumomediastium, or pneumothorax after NAVA catheter placement should raise suspicion for perforation of esophagus
• A NAVA catheter that is too straight after placement and that does not gently curve into stomach should be suspected of not being in stomach
• A NAVA catheter tip that projects over the pelvis should be suspected of not being in stomach
• Pneumoperitoneum after NAVA catheter placement is due to perforation of stomach