NGT placement - page 2

I would appreciate advice on NGT placement. On a previous shift I placed and NGT tube without difficulty, varified by asculation at the epigastrum and had clear gastric return. The ER doc then... Read More

  1. by   Jedi_Iatros
  2. by   rn29306
    Man did I hate putting down an NGT while in the unit. I've had an esophageal dilitation done without any sedation, just bananna spray down the mouth, so I know how it feels to have something put down. And I wouldn't wish that on anyone.

    What is suprising to me is the low incidence of complications from NGT insertion. Only a cm or two separates the esophagus and trachea, but at least with swallowing the trachea seals itself. Please be very careful of putting an NGT down a combative or restrained patient. I realize these people try our patience to no end, but I've seen one combative patient get an acute pneumo that required immediate needle decompression with an NGT attempt.
  3. by   LVNwannaBE2007
    [quote= I can understand freaking out as a new RN if you had never seen the NG snake through the mouth. In school, many students never get a chance to place one on a real pt, only in mannequins, and nothing ever goes into the wrong place on mannequins!
    [/quote]
    wanna bet they dont go in the wrong stop? when i was putting in my ng tube into a mannequin it looked like there was a snake goin through its brain.... lol it went straight up and not down....... dang mannequin didnt listen nad tilt his head down lol
  4. by   precious33
    If the patient is alert then simply ask him/her to swallow while gently slide the tube down.It is always good to position the patient in an upright position.In my hospital we listen withe the stethoscope or confirm with stomach content aspiration or submerge the end the end of the line in water and observe for bubbles.
    same goes for the babies except you can,t ask them to swallow.
  5. by   ERRNTraveler
    Quote from precious33
    If the patient is alert then simply ask him/her to swallow while gently slide the tube down.It is always good to position the patient in an upright position.In my hospital we listen withe the stethoscope or confirm with stomach content aspiration or submerge the end the end of the line in water and observe for bubbles.
    same goes for the babies except you can,t ask them to swallow.
    With babies, sometimes you can use a pacifier with sweetez on it to get them to swallow, but this only works SOMETIMES, as usually they are screaming their heads off too much to care about the pacifier.....
  6. by   mshultz
    When I was in the ED, I was told to sit with my legs hanging over the side of the bed. While one nurse was inserting the NGT, a second nurse was squirting water into my open mouth with a 16 oz Fisherbrand wash bottle (I am a water/wastewater lab tech, so I recognized the bottle even without my glasses). The nurse squirting the water would periodically yell SWALLOW!. Placement was verified with 2 X-rays at the bedside.

    I have not seen the wash bottle technique mentioned on this site, but it seems to me to be an improvement over having the patient take sips of water. If I ever have to undergo this again, though, I am going to ask for hearing protection. When I was transferred to the ICU, they put an NGT into another patient. Even though the patient was in a separate room, I could hear the SWALLOW! command without difficulty.
  7. by   sfsn
    I was wondering, is there anything wrong w/ having the patient lie supine while inserting the NGT?

    I recently had a basically comatose pt. who had to remain supine (for what reason I don't remember) and I had to put an NGT in. The pt. was unable to follow commands such as putting chin to chest, etc., so they basically just lay there while I inserted the tube. And I have to say it was so easy.

    Then a few days later one of my coworkers was having a hard time getting an NGT in her patient. She had tried multiple times with the whole sitting up, chin down, swallow sips of water technique and she just couldn't get the tube in. The poor pt. was miserable. So I asked if I could try it supine (just had the pt. relax, no swallowing or sipping water) and it worked like a charm.

    Is this a bad idea?
  8. by   LilgirlRN
    Before inserting the NG tube, I place the end of the tube over the stomach and walk my way back up the tube, I hold the tube up to the nose and then over to an ear. I make a mark on the tube with a sharpy marker, then when I insert it that's where I stop ... when the mark is even with whichever nare I decide to use.

    Before I start to insert the tube, I examine the nose, I ask if they've evre broken it etc, making sure to go in whichever one is larger. Before inserting I take qtips, dip them in lidocaine jelly (I ask if they're allergic first) I put one qtip in each nare because sometimes if it won't go down in the one I've chosen then I'll have to swap sides. I spray the back of the throat with Cetacaine. I try to have an assistant that can shovel in ice chips and encourage the patient to swallow. Once it's down I take benzoin and apply to the bridge of the nose. I take a 4 inch piece of one inch wide transpore tape and split it about half way up. I apply the end that's not split to the benzoined nose then wrap each end of the split end around the tube once placement is confirmed by ausculatation and suction of stomach contents. I would not insert anything into the tube without confirmation of placement by xray

    I'll have to go along with Tom, tubes can become dislodged during the trip to radiology... that's why marking it is so helpful then you know it's not right if the mark isn't up against the nose. I know that the tube is already marked but there's no numbers on them so you can't tell (at least I can't) which one is which.
  9. by   ERRNTraveler
    Quote from sfsn
    I was wondering, is there anything wrong w/ having the patient lie supine while inserting the NGT?
    Some of the easiest NG tubes I've placed have been on supine, unconscious patients. If they're unconscious & don't have a gag reflex, the tube is just going to go down easier. Nothing wrong with that, just make sure you verify placement by auscultation & aspiration of gastric content. If you can't aspirate gastric content, might want to get a chest x-ray to make sure the tube is in the right place & is down far enough.
  10. by   StacieRN
    If you are not short on time, the easiest was that I have found is to insert the tube until it hits the back of the throat. Hold it LIGHTLY. Wait and as the patient naturally swallows the tube will get tugged down the esophagus.

    You can try to rush this by giving drinks of water. I really prefer not to though. Sometimes the patient chokes. And you have to keep track of the cup, straw, and/or spoon while dealing with the NGT. (TOO MUCH TROUBLE) It's just easier for me to wait until the patient swallows naturally.

    The upsides of this method are that as the esophageal muscles are doing the inserting and that the airway is sealed off while swallowing - you always get into the correct place. And you can use this method while the patient is prone.

    Best of luck!
  11. by   alvarea
    PLEASE HELP!
    I had the worst experience inserting an NG tube last year. It was only my second attempt at inserting a NGT. After inserting into the right nare i kept advancing the tube. After being unable to auscultate to ensure proper placement, we ordered an xray. Before t he cxr, we decided to change the babies diaper, upon doing so we realized the tip of the NG tube was protruding throught the ANUS! What did I do wrong!
  12. by   ERjodiRN
    Quote from alvarea
    PLEASE HELP!
    I had the worst experience inserting an NG tube last year. It was only my second attempt at inserting a NGT. After inserting into the right nare i kept advancing the tube. After being unable to auscultate to ensure proper placement, we ordered an xray. Before t he cxr, we decided to change the babies diaper, upon doing so we realized the tip of the NG tube was protruding throught the ANUS! What did I do wrong!
    you just advanced it too far.....straight through the stomach and jejunum.
  13. by   Pixie.RN
    Quote from alvarea
    What did I do wrong!
    Always measure the tube against the patient first. You should know how far to advance it before doing so.

close