Research Output

NHS safety agency issues guidance on naso-gastric tubes.

  The National Patient Safety Agency (NPSA) advice on reducing
the harm caused by nasogastric tubes1 is limited by poor quality studies
which comprise case studies, small prospective studies, retrospective
studies and no randomised clinical trials. Their suggested method to
measure tube position is checking the pH of gastric aspirate1, but pH
readings are influenced by medication and enteral feed also it may be
difficult to aspirate from fine bore tubes2,3. This may lead to an
increase in the use of x-rays which are only accurate at one point in
time, increase radiation exposure, are not cost effective4 and not always
practical/possible in patients’ homes or small hospitals.

They recommend that injection of air down the tube and auscultation
over the stomach, “the whoosh test” be abandoned on the basis of small
studies and case reports3. Using "the whoosh test" alone has led to deaths
from undetected tube displacement, although in terms of the total number
of tubes inserted the absolute risk of death from tube displacement is
probably small. However if two imperfect tests such as “the whoosh test”
and pH measurement are used in combination it seems obvious that the
overall accuracy will increase.

Basing clinical practice on imperfect advice is not ideal, however we
believe that “the whoosh test” could be made more reliable with the
introduction of a proper protocol and staff training. Training is
essential although difficult without adequate research. Perhaps the NPSA
are not going far enough in funding a systematic review. We believe that
prospective studies which test the sensitivity and specificity of the
methods for confirming tube position against a gold standard such as tube
insertion under x-ray guidance are urgently required.

  • Type:


  • Date:

    30 November 2004

  • Publication Status:


  • Publisher

    BMJ Publishing Group

  • DOI:


  • ISSN:


  • Library of Congress:

    RT Nursing

  • Dewey Decimal Classification:

    610.73 Nursing


Mahoney, C. M., Rowat, A. M. & Dennis, M. S. (2004). NHS safety agency issues guidance on naso-gastric tubes. BMJ British medical journal. 330, 438. doi:10.1136/bmj.330.7489.438. ISSN 1468-5833



Adult intensive care; "whoosh" test; nasogastric feeding tubes;

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