Evidence and practice

Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base

Michael Tatterton Clinical director, Bluebell Wood Children’s Hospice, Sheffield, and associate professor of children and young people’s nursing, University of Bradford, Bradford, England

Jane Mulcahy Nurse consultant for children’s community nursing and complex care, Sussex Community NHS Foundation Trust, East Sussex, England

Joanna Mankelow Senior children’s dietitian, First Community Health and Care, Salfords, Surrey, England

Maria Harding Matron for children and young people’s community nursing, Sussex Community NHS Foundation Trust, East Sussex, England

Jacqui Scrace Associate director for children and young people (South West Region), NHS England, Leeds, England

Megan Fisher Assistant professor of children and young people’s nursing, University of Bradford, Bradford, England

Claire Bethell Advanced nurse practitioner, Bluebell Wood Children’s Hospice, Sheffield, and lecturer in children and young people’s nursing, University of Bradford, Bradford, England

Why you should read this article:

• To re-examine the evidence base that underpins the management of nasogastric tube safety in children
• To recognise the consequences of delayed or missed feeds in children who receive nasogastric tube feeding
• To enhance your understanding of what checks can be used to ensure a nasogastric tube is safe to use

Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube’s position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home.

Nursing Children and Young People. doi: 10.7748/ncyp.2024.e1493

Peer review

This article has been subject to open peer review and checked for plagiarism using automated software

@MJTatterton

Correspondence

michael.tatterton@bluebellwood.org

Conflict of interest

None declared

Tatterton M, Mulcahy J, Mankelow J et al (2024) Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base. Nursing Children and Young People. doi: 10.7748/ncyp.2024.e1493

Published online: 04 March 2024

Keywords :

child health - clinical - community - community care - enteral nutrition - gastrointestinal - infant feeding - infants - neonatal - nutrition - parents

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07 March 2024 / Vol 36 issue 2

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