NHS safety agency issues guidance on nasogastric tubes
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《英国医生杂志》
New NHS safety advice has been issued on reducing the harm caused by nasogastric feeding tubes that have been wrongly inserted. The alert, from the National Patient Safety Agency, follows 11 deaths of patients in the past two years, including that of one child.
A further 13 incidents have also been reported, one of which caused serious harm to the patient. The agency said this week that it was concerned that unreliable tests were being used by health professionals and carers to check whether a tube had been inserted correctly.
On rare occasions, nasogastric tubes can "take a wrong turning," said the agency抯 medical director, John Lilleyman, and mistakenly go down the windpipe and into the lung rather than the stomach. He said it was possible for this to happen without the staff, patient, or carer realising the error.
"Normally when this happens a patient is in considerable discomfort and starts coughing. Rarely, the patient does not experience this or it may be that they are unconscious," he said.
Professor Lilleyman said that the modern, fine-bore tubes that are most commonly used did not irritate the lungs as much as the old-style, large-bore tubes, making it harder to detect errors.
The agency warned that some of the tests currently used to check the placement of the tube could be inaccurate, sometimes fatally so. It issued a list of recommended tests including measuring the acidity/alkalinity of aspirate (stomach contents) using pH indicator strips in the range 0 to 6 with half point gradations; testing the aspirate should not be done with blue litmus paper.
Radiography is recommended for intensive care patients or neonates but should not be used routinely. Individual risk assessments should be carried out before nasogastric tube feeding, the advice adds.
The agency emphasised that several tests still in use should be stopped immediately. This included the "whoosh" test, which involves the use of a syringe to push a small volume of air down the tube while the sounds produced are monitored with a stethoscope.
The agency also warned against monitoring for bubbling at the proximal end of the tube because the stomach also contains air and could falsely indicate respiratory placement. Likewise, observing the appearance of feeding tube aspirate is also unreliable because gastric contents can look similar to respiratory secretions.
Nasogastric tubes are in widespread use in the NHS; the agency estimates that at least one million tubes are purchased by the NHS each year. It said that many feeding tubes were now being fitted by carers in domestic settings, although all of the recorded deaths had occurred in hospital settings in England.(London Rebecca Coombes)
A further 13 incidents have also been reported, one of which caused serious harm to the patient. The agency said this week that it was concerned that unreliable tests were being used by health professionals and carers to check whether a tube had been inserted correctly.
On rare occasions, nasogastric tubes can "take a wrong turning," said the agency抯 medical director, John Lilleyman, and mistakenly go down the windpipe and into the lung rather than the stomach. He said it was possible for this to happen without the staff, patient, or carer realising the error.
"Normally when this happens a patient is in considerable discomfort and starts coughing. Rarely, the patient does not experience this or it may be that they are unconscious," he said.
Professor Lilleyman said that the modern, fine-bore tubes that are most commonly used did not irritate the lungs as much as the old-style, large-bore tubes, making it harder to detect errors.
The agency warned that some of the tests currently used to check the placement of the tube could be inaccurate, sometimes fatally so. It issued a list of recommended tests including measuring the acidity/alkalinity of aspirate (stomach contents) using pH indicator strips in the range 0 to 6 with half point gradations; testing the aspirate should not be done with blue litmus paper.
Radiography is recommended for intensive care patients or neonates but should not be used routinely. Individual risk assessments should be carried out before nasogastric tube feeding, the advice adds.
The agency emphasised that several tests still in use should be stopped immediately. This included the "whoosh" test, which involves the use of a syringe to push a small volume of air down the tube while the sounds produced are monitored with a stethoscope.
The agency also warned against monitoring for bubbling at the proximal end of the tube because the stomach also contains air and could falsely indicate respiratory placement. Likewise, observing the appearance of feeding tube aspirate is also unreliable because gastric contents can look similar to respiratory secretions.
Nasogastric tubes are in widespread use in the NHS; the agency estimates that at least one million tubes are purchased by the NHS each year. It said that many feeding tubes were now being fitted by carers in domestic settings, although all of the recorded deaths had occurred in hospital settings in England.(London Rebecca Coombes)