Complications During Insertion of Narrow-Bore Feeding Tubes

To the Editor.—  Hand et al¹ described inadvertent transbronchial insertion of narrow-bore feeding tubes into the pleural space. Schorlemmer² was the first to describe this. His three patients all suffered a pneumothorax after the feeding tube was inserted with a wire guide. A depressed gag reflex allowed for easy insertion into the larynx and the wire guide was implicated in perforating the pleura. He suggested immediate radiographic confirmation of tube location before commencement of feedings, and use of the wire guide only for passage of the nasopharynx.Having experienced similar occurrences at our institution (D.M.A., G. Berci, MD, unpublished data, January 1984) we advocate not using the wire guide at all. To pass the tube, we attach the tip of a small-bore feeding tube to the tip of a rigid Levine nasogastric tube with half of a gelatin capsule (as used for encapsulated medicine).³ The rigid nasogastric