Reducing the harm caused by misplaced naso and orogastric feeding tubes in babies under the care of neonatal units

This patient safety alert informs healthcare staff about the risks of using gastric feeding tubes (both nasogastric and orogastric) for neonates.

There is a small risk that the tubes can be misplaced into the lungs during insertion, or move out of the stomach at a later stage.

Studies have shown that testing methods to check the placement of nasogastric feeding tubes in adults and children can be inaccurate. These include:

Auscultation of air insufflated through the feeding tube (‘whoosh’ test). Experts have repeatedly highlighted the difficulties in using this method.
Testing acidity/alkalinity of aspirate using blue litmus paper, which is not sensitive enough to distinguish between bronchial and gastric secretions.

• Interpreting absence of respiratory distress as an indicator of correct positioning, because bore tubes can enter the respiratory tract with few, if any, symptoms.
• Monitoring bubbling at the end of the tube, which could falsely indicate gastric placement. 
• Observing the appearance of feeding tube aspirate, because gastric contents can look similar to respiratory secretions.

Primary care organisations England and Wales should:

• give staff, and carers of babies in the community, information on correct and incorrect testing methods;
• carry out an individual risk assessment prior to gastric tube feeding;
• review and agree local action required; and
• report misplacement incidents via their local risk management reporting systems.