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When someone is unwell in hospital they may need to have a tube inserted to help them breathe or to enable them to take in fluids, food or medication. If these tubes are not inserted correctly, or are misplaced or dislodge, then the result can be devastating. In these circumstances, claims can often be made for compensation.
Feeding tubes
Nasogastric (NG) tubes are used for artificial feeding, hydration and the delivery of drugs to those unable to swallow safely (often known as dysphagia). They are thin polyurethane tubes that are inserted through the nose and down into the stomach. There are about one million tubes purchased annually by the NHS. These are normally for short-term use, after which there are risks of complications. At this point a more permanent gastrostomy feeding route (PEG) needs to be considered.
When NG tubes are misplaced and then used, these are classed by the NHS as ‘Never Events’ (serious incidents which are largely preventable). Nonetheless, such incidents do still happen. When misplaced, a tube can end up with the tip lying in the lungs or trachea, causing pulmonary complications and even death. The tube can also pierce or enter the bowel or stomach.
Often those requiring NG tubes are in a particularly vulnerable position. Stroke survivors, for whom dysphagia is not uncommon, are an example. According to the journal Radiology Case Reports, stroke survivors may have poor ability to cooperate during the insertion of feeding tubes and a reduced or absent cough reflex, increasing the likelihood of a tube being inserted into the trachea.
The Healthcare Safety Investigation Branch (HSIB), an organisation dedicated to improving patient safety in the NHS, has highlighted concerns about the variation in the way safety standards are implemented and monitored. Their investigation found that, even though research suggests x-ray is considered the most accurate method to confirm that an NG tube is in the right place, the most common cause of NG tube incidents is, nonetheless, incorrect x-ray confirmation and interpretation.
The HSIB also found that there was no consistent process for assessing and recording competency with regard to NG tube placement. It recommended that Health Education England should develop and publish a national training programme to standardise confirmation of correct placement. According to the HSIB website, no response has currently been received to that recommendation.
Breathing tubes
Intubation is a process by which a tube (usually known as an endotracheal tube) is inserted through the mouth (or the nose) and down the trachea to deliver oxygen to the lungs. If the tube is misplaced it can end in a patient’s oesophagus, blowing air into the stomach. If the tube is placed too high, it can rub against the vocal chords and cause chord trauma. If the tube dislodges and this is not recognised then it can block the airway. Some of these incidents can lead to the brain not getting sufficient oxygen (known as a hypoxic injury) and in turn cause a profound brain injury. The result of a misplaced or displaced tube can be fatal.
Two recent inquests have highlighted that the misplacement of breathing tubes continues to be a danger. At the inquest into the death of a 13-year-old Covid victim, the Coroner found that the misplacement of an endotracheal tube contributed to his death. It was reported that the consultant involved accepted that it was an oversight that she did not see the tip of the tube and that it was too high.
At a further inquest into the death of a young woman it was found that there was a problem with her tracheostomy tube (a tube to help breathing which is inserted into the windpipe through an opening at the front of the neck), which suddenly displaced leading to a cardiac arrest. The Coroner recorded that the cardiac arrest was caused by a lack of oxygen as no re-intubation was possible after the displacement. The Coroner also recorded that there were serious issues of care as there was no individualised planning for the possibility of displacement or plan to ensure that the correct equipment or senior help was available as quickly as possible should this occur.
How we can help
At Kingsley Napley, we have experience in dealing with medical negligence claims of this nature including where brain injuries result from issues with tube placement. We provide a highly supportive service to support our clients and their families, seeking to obtain the maximum award of much needed compensation.
FURTHER INFORMATION
If you would like any further information or advice about the topic discussed in this blog, please contact Richard Lodge or our Medical Negligence and Personal Injury team.
ABOUT THE AUTHOR
Richard Lodge is a Partner in the Medical Negligence and Personal Injury practice and has been recognised within the field of clinical/medical negligence within the Chambers UK and Legal 500 directories. He is an individually ranked lawyer for clinical negligence within Chambers UK, A Client’s Guide to the UK Legal Profession.
We welcome views and opinions about the issues raised in this blog. Should you require specific advice in relation to personal circumstances, please use the form on the contact page.
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