Surgery Godfather
Chapter 1194 - 933: The Misguided Stomach Tube_2

Chapter 1194: Chapter 933: The Misguided Stomach Tube_2

Yang Ping felt it was nothing unusual; not only could a nasogastric tube accidentally be inserted into the skull, but it could also end up in the heart—it’s rare, but not impossible. To educate the nurses to strictly follow procedural protocols, Head Nurse Cai once taught a class about "The Misplaced Gastric and Urinary Catheters." Since there was nothing much to see in the ongoing surgery, as Director Gao was very familiar with the procedure, Yang Ping decided to check out the Neurosurgery department.

Silently, Yang Ping stood in front of the light box displaying the CT images. There, a strikingly obvious tubular foreign body entered through the nasal cavity, crossed the sella of the skull base directly into the cranial cavity, took a bend passing through the brain and brainstem regions, and entered the vertebral canal via the foramen magnum of the occipital bone. Moreover, there was a large amount of heterogeneous-density liquid-solid mixture within the cervical vertebral canal, compressing the spinal cord to some extent.

The CT scan was chilling to look at; such a mistake could be lethal at any moment. The nasogastric tube passed through the brainstem, which is central to life functions.

Given the problem, the nurse who had inserted the nasogastric tube at the time was very likely an old hand, overconfident in their intubation skills and had even skipped the step of aspirating gastric content for verification.

Rubbing his chin, Yang Ping concluded from the CT images that there was a bone defect in the sellar region at the base of the skull. There were radiopaque metal artifacts within the skull, ventricular enlargement, and accumulation of blood/fluid/gas.

It looked as though there had been a recent tumor excision surgery in the sellar region of the skull, which explained the bone defect. Otherwise, how could there be a bone defect in that area? It’s unrealistic to think that a nasogastric tube could penetrate a normally sturdy sellar region of the skull base on its own.

Many tumors in the sellar region are resected via a transnasal-transsphenoidal approach to avoid craniotomy. This relatively minimally invasive surgery removes the tumor through a small hole created by removing the thin bone between the nasal cavity and the cranial vault.

It’s possible the nurse wasn’t aware of the patient’s recent history of sellar region tumor surgery and inserted the nasogastric tube as usual. Consequently, the tube entered the cranial cavity through the bony defect, and the nurse continued to insert it to the usual depth until satisfied, inadvertently threading the tube into the cervical vertebral canal.

A nasogastric tube isn’t meant to go into the brain casually; if there were no bone defect between the nasal cavity and the cranial cavity, it’s impossible for the tube to penetrate into the cranial cavity. Thus, the prerequisite for a nasogastric tube entering the cranial cavity is the absence of bone at the skull base, allowing the tube an opportunity to slip through.

In fact, this wasn’t the first case Yang Ping had heard of where a nasogastric tube entered the intracranial space. There had been another case with a recent medical history of sellar region tumor resection, but in that case, the tube didn’t continue into the vertebral canal, but rather looped inside the skull.

One relative contraindication for nasogastric intubation is: skull base fracture. If there is a fracture at the skull base, inserting a nasogastric tube can lead to inadvertent entry into the brain, hence every clinical procedure manual is written in blood and tears.

After inserting the nasogastric tube, it’s critical to check if the tube is actually in the stomach. There are a few methods: withdraw stomach content through the tube using a syringe—if gastric fluid or content is extracted, it proves the tube has entered the stomach as such fluids can’t be aspirated from other locations.

An auscultoscope is placed below the xiphoid process, and if air is injected into the nasogastric tube (10-30ml) and a gurgling sound is heard, it indicates the tube has reached the stomach.

If the end of the nasogastric tube is placed in water and bubbles are seen coming out in large amounts, it means the tube has mistakenly entered the airway and should be immediately removed and reinserted.

Of these, the first method is the most reliable.

While everyone was busy with the surgery, no one noticed Yang Ping’s arrival. The surgery wasn’t simple, as the tube had passed through the brainstem, and any surgery involving the brainstem is complex. The surgery involved not only removing the nasogastric tube but also clearing the liquid content from both the cervical vertebral canal and the cranial cavity, with a greater amount in the vertebral canal.

Director Shi of Neurosurgery was chatting with an assistant, "How come it’s Affiliated Hospital No. 4 again? Wasn’t Director Qian from there arrested?"

"Finding one cockroach usually means there’s a nest hidden. Do you think Director Qian could act so brazenly for so many years just by luck?" remarked a Doctor, whose identity wasn’t clear.

Director Shi responded, "You shouldn’t talk recklessly. Young man, you must take responsibility for your words."

"Not like I’m at Affiliated Hospital No. 4, are they going to discipline me across hospitals?"

"That won’t happen."

It turned out this patient had been transferred from Affiliated Hospital No. 4. After the insertion of the nasogastric tube, the patient unexpectedly developed high-level paraplegia. Since the patient had undergone sellar region tumor excision surgery in the skull, the head of the medical team immediately ordered a repeat CT scan to check for any issues related to the original surgery. The result was striking—the nasogastric tube had entered the brain and even curved into the cervical vertebral canal, with the cervical spine and cranial cavity containing an unclear mixture of heterogeneous liquid-solid density.

The team leader pulled the nurse aside to ask her about the situation. The nurse was very pretty, but she had a big attitude, pouting and clearly unhappy, "I’ve always inserted it this way, and nothing has gone wrong before. How could it possibly be related to the feeding tube?"

The team leader put up the CT scan, "The feeding tube was inserted into the brain, the patient is now paralyzed, and you’re still acting all high and mighty. Where does this confidence come from?"

The nurse immediately became frightened, and the team leader asked, "After inserting the feeding tube, did you inject anything into it?"

The nurse hesitated, not daring to conceal the truth, "I didn’t know it was inserted incorrectly, I thought it was in the stomach, so I injected nutrient solution."

The big brother in charge felt his legs go weak, and he was completely stunned, "Didn’t you withdraw any fluid to check after inserting the feeding tube?"

"I did withdraw some fluid; it was clear with a slight reddish tint. I thought it was gastric juice. You know, the patient hasn’t been eating much," the nurse recalled the incident.

The team leader understood all too well, they were doomed. The fluid that was withdrawn was bloodstained cerebrospinal fluid—how could they not see this as a disaster? How would they resolve this?

"Affiliated Hospital No. 4 needs a shake-up. Look at City People’s Hospital, they’re managing things well now, but they used to be a mess too. Remember that ’Smile Service’ nonsense they tried before? It killed me," Director Shi continued the topic, to prevent the young crowd from complaining.

The first assistant, a deputy chief physician, was also familiar with the once-notorious ’Smile Service,’ "I heard they set up a special inspection team, full of idle folk who didn’t do any real work. They would make undercover visits daily, and if they saw any doctors not smiling at patients or their families, they would immediately note it down and deduct money. They were pretty ruthless. I had a classmate who worked at City People’s Hospital, and I heard it was a 500-yuan fine each time. Those in the inspection team got a commission out of it."

"Bloody idiots, I had a master’s classmate there at the time too. His mentor had just finished trying to rescue a patient with liver cancer who didn’t make it. After announcing the death to the family, the inspection team accused him of not smiling and noted him down for a 500-yuan deduction. When he complained, the inspection team didn’t give a damn, saying it was the rule. My classmate slammed the table and cursed."

"It wasn’t just the Smile Service, back then they also had this stupid ’One-Stick Convenience Initiative’!"

"What is the One-Stick Convenience Initiative?"

"Nurses had to succeed with an injection or IV on the first try, if they needed a second attempt, the nurse giving the injection would be fined thirty yuan. For a third try, more money was deducted, and so on. They even put up a sign welcoming complaints in the ward and the IV room. It was a bit better in other departments, but the pediatric nurses especially were having a hard time, getting fined who knows how many times a day."

"Even if you walked away, it’s not like it’s the only hospital around."

The conversation started with Affiliated Hospital No. 4 and then switched to City People’s Hospital. Yang Ping was quietly looking at the CT images with his back to everyone, and nobody had noticed until now.

Just as Yang Ping was about to leave, a young doctor saw him, "Professor Yang!"

All the doctors and nurses looked over, even the chief surgeon, Director Shi, lifted his head and looked around for Professor Yang. In Sanbo Hospital, usually people address each other as Director so-and-so, Doctor so-and-so, or Old so-and-so, Young so-and-so. They don’t usually use the title Professor, as they are clinical doctors, so when they heard the name Professor Yang, they knew who it was.

Director Shi saw Yang Ping at the entrance, "Professor Yang, I’m sorry, I didn’t see you just now."

"I was checking on the Sports Medicine side and thought I’d stop by to see your surgery," Yang Ping paused in his tracks to speak a few words.

Director Shi said, "It’s a peculiar case, a feeding tube inserted into the cranial cavity and the vertebral canal. Quite strange indeed."

"I just saw that."

"The nurse didn’t know, she even injected a tube of nutrient solution inside."