Feeding tube safety: National guidance is unsafe and must change.

National guidance advises post-procedure pH or X-ray checks to prevent use of tubes misplaced in the respiratory tract; this occurs in 0.017% of placements. However, post-procedure checks cannot prevent the in-procedure pneumothorax in 0.43% or pneumonia from contamination in 0.20%. Extrapolated for annual Europe + USA tube placements there would be ∼ 71,500 complications.Mid-procedure CO2 checks or guided tube placement can prevent 96-100% of these complications whilst pre-emptive bridle securement reduces risk by 40% by obviating the need for most tube replacements. Together these methods would radically reduce holistic risk and cost.National guidance is obsolete and disincentivises improvements in patient safety. In-procedure tube position checks, pre-emptive bridling and evidence-based training should be recommended.