"Lariat loop" knotting of a nasogastric tube: an ounce of prevention.

Iatrogenic complications in medicine are increasing in frequency, especially in critical care environments because of the use of invasive procedures and monitoring. Although nasogastric tubes are routinely used for decompression and/or feeding of critically ill patients, the number of potential complications almost exceeds the indications for use. Knotting of small-bore feeding tubes and nasogastric tubes, during both insertion and removal, is rare, but it can lead to serious complications including respiratory distress, severe laryngeal injury, and tracheoesophageal puncture. Knotting of large-caliber nasogastric tubes is even more uncommon. In this report we describe a case of “lariat loop” knotting of a plastic nasogastric tube during removal of the tube.