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.