Neurally Adjusted Ventilatory Assist Catheter Malfunction

  • Etiology: Placed in patients who require ventilatory assistance
  • Imaging: Correct NAVA catheter tip position should be in the body of the stomach
  • DDX: NAVA tube mimics include nasogastric tube which does not have a pointed end, esophageal temperature probe which has a twisted wire appearance, esophageal pH probe which has numerous linear marks along its length and transesophgeal echocardiogram probe which has a very wide diameter and a sensor at the end
  • Complications:
    — 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 the NAVA catheter
  • Treatment: Repositioning or replacement of malpositioned catheter
  • Clinical:

Radiology Cases of Neurally Adjusted Ventilatory Assist Catheter Malfunction

Radiology Cases of Neurally Adjusted Ventilatory Assist Catheter Normal Position

CXR of correct NAVA catheter placement in patient with chronic lung disease.
CXR AP shows a NAVA catheter with its tip projecting over the body of the stomach, a nasogastric tube with its tip projecting over the body of the stomach, and a left upper extremity PICC with its tip projecting over the brachiocephalic vein. There are fine interstitial infiltrates present throughout the lungs

Radiology Cases of Neurally Adjusted Ventilatory Assist Catheter Too High in Position

CXR of high position of neurally adjusted ventilatory assist catheter / NAVA catheter
CXR AP (left) shows the tip of the nasogastric tube to project over the body of the stomach. The tip of the NAVA tube projects over the proximal esophagus. Repeat CXR AP obtained after repositioning of the NAVA tube (right) shows the tip of the NAVA tube to now project in correct position over the body of the stomach alongside the tip of the nasogastric tube.

Radiology Cases of Neurally Adjusted Ventilatory Assist Catheter In The Right Mainstem Bronchus

Neurally Adjusted Ventilatory Assist (NAVA) catheter malposition in the right mainstem bronchus
CXR AP shows the tip of the NAVA catheter to project over the right mainstem bronchus. The tip of the nasogastric tube projects over the fundus of the stomach. A VP shunt is also present coursing along the left chest.