Quote from stephynic21
She had unsuccessful intubation attempts prior to arrival in the ER via EMS but successful the first time in the ER by the doc...so i guess stomach contents are possible if there was aspiration. there was no problem with insertion of the NG, tho. It went down easily as it ever has. I would think in order to get passed the ETT it would have to somewhat forced but it slid in easily. And I did ask the doc when he asked for one "NG or OG" and he said NG was fine. I just can't wrap my head around how it became displaced.
Even with the cuff inflated in the ETT the NGT could get in the trachea. The ETT might have been small for the airway. If the ED MD knew of the unsuccessful attempts he might have used a smaller tube. I have placed MANY NGTon MANY intubated patients after MANY codes/intubations. Preference to OGT/NGT is regional/personal preference or......injury driven.
Even if you PH tested these contents they would have tested as gastric contents for the patient probably aspirated their gastric contents in the field with the intubation attempts to as a result of the arrest itself.
I have often wondered why codes in the field always seem to have eaten a huge meal....
. It makes everything more complicated.
Back on track......It is always not so hard to get past the ETT. That is why we as nurses INFUSE NOTHING in a NG/OGT until placement is verified. Hooking up the NGT to suction, short term, would not have caused any harm.....it would have sucked out the gastric contents in the lungs and you might have heard it the patients throat. You apply suction to the lungs every time you suction the ETT.
What is with the blame game.....it is one of those known complications of placing an OG/NGT and it could happen to anybody. Heck I have gotten open hearts back hat the NGT was in the wrong place. It is why I check my NGT placement before every med given through the NGT and if they aren't in far enough they can migrate....but not likely. The reason we check for placement is because it can go into the lung. Once in the lung....take it out and start again.
Is the coordinator a critical care trained nurse? Has she ever placed a NGT on an intubated fresh code with vomit in their lungs? What is wrong with everyone these days? This Calling in to offices and raking people over the coals.....this blame game baffles me. NGT/OGT insertion is another acquired skill that will get better with practice.
You can't really vomit around the ETT balloon? A ETT is an EndoTracheal Tube in the lungs. It is down the trachea in to lungs.....there is no (or shouldn't be) any vomit coming from the lungs whether the balloon is inflated or not.....and yes patient can vomit with an ETT tube in place because Te esophagus remains patent....that is why we place the NasoGastric Tube. It is also why a patient is intubated....to protect the airway.
The projectile vomiting that can occur is from the gag reflex during intubation on an under sedated patient OR stimulation on a full stomach compressed with air from extended bagging (using the amber and face-mack) during resuscitation.......the stomach will only take so much pressure build up before it takes the path of least resistance....the esophagus.
OP....I would have probably removed it and then gotten the charge nurse/MD if I couldn't hear the placement. I usually wait for the CXR ETT placement to double check the NGT is in the right place before instilling any thing. On a patient that is unconscious I would probably insert the NGT orally.....but I have done both...I will also tend to use the right nares for a straighter shot.
Why they called you in? I have no idea....but I also don't know the whole story. Did the primary nurse also get called in? Is was after all, her patient.
YOu will get better with practice.