Feeding Tube Malfunction / Malposition / Misposition / Misplacement

  • Etiology: placed in patients who have trouble eating to provide nutrition
  • AXR:
    — a feeding tube tip that crosses to the right of the spine and then heads superiorly before turning back to the left of the spine is most likely still in the stomach
    — a feeding tube tip that crosses to the right of the spine and then heads inferiorly before turning back to the left of the spine is most likely in the duodenum or jejunum
    — feeding tube tip should be transpyloric in position, ideally near the duodenal-jejunal junction or in the proximal jejunum
  • Complications: placement of the feeding tube tip into the airway can result in pneumothorax or aspiration with feedings, perforation of the gastrointestinal tract during feeding tube placement, placement of the feeding tube tip proximal to the duodenal-jejunal junction, kinking of the feeding tube tip leading to its obstruction, migration of the feeding tube tip out of the duodenum
  • Treatment: further advancement of proximally placed feeding tube, replacement of kinked feeding tube
  • Clinical: presentations include what is being infused though the feeding tube is being aspirated out of a nasogastric tube in the stomach, inability to infuse through feeding tube

Cases of Feeding Tube Malfunction / Malposition / Misposition / Misplacement

AXR of feeding tube in mainstem bronchus, lung and pleural space with tension pneumothorax
AXR obtained immediately after feeding tube placement (left) shows a feeding tube going down the left mainstem bronchus and then turning up into the lung and increased lucency in the left costophrenic angle presumably due to the feeding tube entering the left pleural space. AXR obtained a minute later after feeding tube repositioning (right) shows the tip of the feeding tube in the antrum of the stomach and a large left pleural air collection with mediastinal shift to the right.
AXR of feeding tube with tip in the esophagus
AXR shows a feeding tube entering the stomach and then looping back upon itself into the proximal esophagus.
AXR with feeding tube tip in the stomach
AXR shows a feeding tube coursing along the greater curvature of the stomach with the tip looping back upon itself in the body of the stomach. A nasogastric tube is also present with its tip within the body of the stomach.
AXR with feeding tube tip in the first part of the duodenum
AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus with the tip in the first part of the duodenum. A nasogastric tube is also present with its tip within the body of the stomach.
AXR with feeding tube tip in the second part of the duodenum
AXR shows a feeding tube coursing through the stomach and then passing through the pylorus with the tip in the second part of the duodenum. A nasogastric tube is also present with its tip within the fundus of the stomach.
AXR of feeding tube tip in third part of duodenum
AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus and duodenum with the tip in the third part of the duodenum. A nasogastric tube is also present with its tip within the body of the stomach.
AXR with feeding tube tip in proximal jejunum
AXR shows a feeding tube coursing along the greater curvature of the stomach and then passing through the pylorus and duodenum with the tip in the proximal jejunum. A nasogastric tube is also present with its tip within the body of the stomach.
US of feeding tube tip in main portal vein
Transverse US of the liver shows the echogenic tip of a feeding tube to be in the main portal vein in the center of the image. Note the posterior shadowing from the tip extending inferiorly from it.