A 10-year-old girl was killed by a nurse who botched the insertion of a feeding tube into her stomach and then ignored danger signs in defiance of national guidelines, a court has heard.

Phoebe Willis screamed in pain and started bleeding when Carrie-Anne Nash pushed the tube in despite feeling something blocking its way, a jury was told.

Nash, 34, a paediatric specialist, ignored a series of “red flag” indicators and sent the youngster home, Bristol crown court heard.

When Phoebe’s mother, Heather Willis, fed her milk before putting her to bed that night it seeped into the cavity between her vital organs, which led to blood poisoning.

The next morning Willis dialled 999 after finding Phoebe looking grey but by the time the ambulance arrived her lips were blue and she had gone into cardiac arrest.

Phoebe died the following evening after further cardiac arrests and brain injury. Nash, from Portishead in north Somerset, was charged with her manslaughter three years later. She denies the offence.

The jury heard that the youngster needed a feeding tube because she suffered from cystinosis, a rare genetic condition.

Since her diagnosis as a baby the tube was changed every three months – described as a simple procedure that her parents had been used to carrying out.

But in August 2012 they decided to take Phoebe to Weston general hospital, north Somerset, after they found it unusually difficult to push a new tube in.

None of the medics on shift were qualified to deal with the situation so Nash, a community nurse employed by Nutricia, a pharmaceutical company, was called in to help.

Sarah Whitehouse QC, prosecuting, said Nash repeatedly attempted to insert the device, known as a mini balloon button. She said: “When she finally succeeded, she didn’t make sure the tube attached to the button was where it should be – extending from the abdominal wall and into the stomach.

“She ignored what are called ‘red flag’ indicators which would have warned her that the tube was not in Phoebe’s stomach. Tragically, the tube wasn’t properly placed and so when Phoebe was fed through the tube, milk did not enter her stomach but rested in the cavity between her organs.”

This caused infection, sepsis and, ultimately, the little girl’s death, the court heard.

Whitehouse told the jury: “This is how Ms Nash came to be charged with manslaughter. Not because she intended to kill Phoebe, or wanted Phoebe to die or be harmed in any way. But because she acted contrary to national guidance, contrary to her employer’s safety protocols and contrary to her training.

“Critically, she failed to recognise or act on ‘red flag’ indicators that suggested there was a serious problem with the tube placement. She provided a level of care to Phoebe that was so very far below the standard to be expected of a nurse with her specialist training that it can properly be described as criminal.”

The trial continues.