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EAD Misplacement a Never Event – Tuesday Tube Facts

EAD Misplacement a Never Event – Tuesday Tube Facts

In the United Kingdom, administering enteral therapy into a misplaced feeding tube is considered a Never Event.*

Never events are defined as ‘serious incidents that are wholly preventable because guidance or safety recommendations that provide strong systemic barriers are available at a national level and should have been implicated by all healthcare providers’.*

NHS England Patient Safety Domain. Revised never events policy and framework; 2015. https://www.england.nhs.uk/wp-content/uploads/2015/04/never-evnts-pol-framwrkapr.pdf. Accessed 20 May 2019.

EAD Misplacement into Lung Can Lead to Death – Tuesday Tube Facts

EAD Misplacement into Lung Can Lead to Death – Tuesday Tube Facts

Of the 1.2 million small bore feeding tubes placed, about 0.1-0.3% of patients die as a result of blind misplacement.*

About 1.2–2 percent of small bore feeding tubes that are placed blindly at the bedside enter the airway undetected. *

* Krenitsky, J. Blind Bedside Placement of Feeding Tubes: Treatment or Threat? Practical Gastroenterology. 2011; March, 32-42.