RCR/BSGAR welcome calls for standardised training for X-ray confirmation of nasogastric tube placement

Thursday 17 December 2020

The RCR and the British Society of Gastrointestinal and Abdominal Radiology (BSGAR) have welcomed a new safety report which calls for standardised training for imaging confirmation of the correct insertion of nasogastric tubes.

Today (December 17), the Healthcare Safety Investigation Branch (HSIB) has released a report into the placement of nasogastric tubes, calling for national training standards in England for the placement and assessment of tube insertions.

The new HSIB report was sparked by the reference case of a young man who had a tube accidentally placed into his lungs while being treated in a critical care ward following a cycling accident. He was then given liquid feed into his lungs for two days before the error was detected.

As well as reviewing the reference case, the HSIB investigation also covered the ongoing occurrence of tube misplacements, which are considered “never events” within the NHS. HSIB found that there were 14 incidents of misplace nasogastric tubes from April-September this year, and remarked that COVID-19 pressures have added to the challenges around confirming correct intubation.

The national investigation examined the placement of nasogastric tubes and their confirmation either by pH testing or X-ray imaging, as well as the NHS safety culture around the procedure, reporting and device specifications and procurement.

The report calls for the creation of national, standardised training for tube placement and confirmation by pH testing, as well as device standards to support national procurement of pH testing strips.

For imaging, the report recommends that BSGAR work with the College of Radiographers (CoR) and Health Education England (HEE) to develop a national training programme for the X-ray-based confirmation of tube placement. It also notes that it would be “beneficial” for critically ill patients with tubes to have their X-rays confirmed by a radiologist or appropriately trained radiographer.

Following the HSIB recommendation on X-ray training, the RCR and BSGAR are due to explore training options with CoR and HEE in the new year.

Speaking on behalf of BSGAR and the RCR, BSGAR President Professor Stuart Taylor said:

“Radiology plays a key role in the care of patients needing nasogastric intubation and the RCR and BSGAR strongly welcomes today’s HSIB report and its recommendation for standardised training.

“Examples of training best practice are already in evidence in this area at several NHS trusts and we will be working with partners from the start of 2021 to improve national outcomes.

“These events must become a thing of the past and we are committed to improving practice across the NHS.”