Affiliations: National Hospital Organization (NHO) Headquarters Kyushu Office, Fukuoka, Japan | NHO Kumamoto Medical Center, Kumamoto, Japan | NHO Kyushu Medical Center, Fukuoka, Japan | NHO Higashisaga National Hospital, Miyaki-gun, Saga-ken, Japan | NHO Omuta National hospital, Omuta, Japan | NHO Minamikyushu National Hospital, Aira-gun, Kagoshima-ken, Japan | NHO Miyazakihigashi National Hospital, Miyazaki, Japan | NHO Kagoshima Medical Center, Kagoshima, Japan | NHO Fukuoka National Hospital, Fukuoka, Japan
Note: [] Address for correspondence: Yoshio Haga, MD, National Hospital Organization (NHO) Kumamoto Medical Center, 1-5 Ninomaru, Kumamoto 8600008, Japan. Tel.: +81 96 353 6501; Fax: +81 96 325 2519; E-mail: [email protected].
Abstract: Misplacement of nasogastric feeding tubes into the respiratory tract often results in tremendous complications such as pneumonia, empyema and pleural effusion. The National Health Service issued advice to prevent these errors in 2005, describing that verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation is a prerequisite condition for feeding. However, the usefulness and feasibility of this advice has not been well evaluated. Our experience to implement this advice revealed the problem that in about 30% of the instances before feeding, such verification is infeasible. Therefore, we suggest the following recommendations by reviewing the literature and caregivers' opinions. 1. Placement of newly inserted tubes should always be confirmed by X-ray before use for feeding or medication. 2. At re-insertion of the tube, verification of pH 5.5 or lower of the aspirate fluid or X-ray confirmation should essentially be performed before medication or feeding. 3. Before every feeding, checking the external length of the tube from the nostril and observing the inside of the mouth should be done to determine if the tube is partially removed or not. If there is no suspicion of tube removal, feeding can be started.
Keywords: Medical errors, feeding tube, misplacement, enteral nutrition
