NHS organisations in England and Wales have been issued a fresh set of guidelines by the National Patient Safety Agency (NPSA) with the aim of limiting the harm caused by misplaced nasogastric feeding tubes.

The Patient Safety Alert updates a previous alert issued in 2005, which was intended to offer guidance on checking and confirming the nasogastric tube had been placed properly into the stomach.

Following the completion date for the 2005 alert, there have been an additional 21 deaths and 79 cases of harm because of feeding into the lungs through misplaced nasogastric tubes.

The Patient Safety Alert sets out a specific set of steps to go through every time a nasogastric feeding tube is inserted and asks clinicians to consider three essential questions:

• Is nasogastric feeding the right decision for this patient?
• Is this the right time to place the nasogastric tube and is the appropriate equipment available?
• Is there sufficient knowledge/expertise available at this time to test for safe placement of the nasogastric tube?

Dr Suzette Woodward, Director of Patient Safety at NPSA, said: "It is unacceptable that patients are still dying from misplaced nasogastric feeding tubes.

"This new alert emphasises that pH remains the firstline test to ensure the nasogastric tube is in place and provides additional information to support the safe interpretation of X-rays to check the placement of nasogastric tubes. Following these simple steps will make this procedure safer."

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