I'm a new grad in the ED and I think I have had to do more NG tubes than I have Foleys, which is weird....
but anyway, I'm pretty comfortable with it now.
Here are my thoughts/methods:
-Explain everything first
-Have bucket, cup of water with straw, and chux ready
-Warm up the tube by wrapping it around your hand a few times to make it flexible
-Do the "sniff check"- occlude one nostril at a time and have the patient inhale through their nose, to see if you can hear a difference in air intake-- if one nostril sounds crowded, consider avoiding that one
-Bring another person with you to facilitate holding the water and the patient's head down (this also helps close off the airway!)
-Plenty of lube on the tip of the tube
-Measure nose to ear to xiphoid (I've begun to think that you can measure all you want, but at the end of the day, you have no idea what the anatomy in there looks like... so do your best to estimate)
-DON'T start until you make sure you have:
a.) functioning suction
b.) a 60cc syringe
d.) silk or cloth tape
e.) a safety pin
-Insert the tube in the nare, with steady but gentle pressure and speed. (pt's head is chin to chest) In my experience, it is best not to stop unless the pt is having breathing difficulty or is vomiting profusely (you know you're in the airway/lung if they cannot speak to you or take in a breath)
-check placement before you secure the tube... have your tech hold the tube while you get your ears on and your syringe with 20cc of air... inject, and listen for the "whoosh" in the epigastric area
-Hook up to suction, and see what you get... you can be reasonably sure you're in the right place if you see what looks like vomit in the canister!
-use mastisol on the nose, with tape on the tube and onto the nose to secure
-tape on the tube with a safety pin to the gown for slack and security
-use high suction at first if the material is thick, just to open up the tube, and then set at prescribed/low wall suction
-position patient for comfort, and double check 02 sats
* use throat spray if pt is very sensitive to pain, otherwise can do without... may inhibit swallowing abilities
* Don't CRAM the tube down... just commit to sliding it in with finesse.
I have seen a few old timers where I work use the "cram it in" method, and it's never pretty or pleasant for anyone
*Gagging is going to happen, plain and simple. A tube in your throat will do that.
* A little blood in the nose is ok- profuse bleeding is obviously not. Use your judgement.. but you're smooshing a tube in what is usually open space, so some tissue trauma is expected.
Go in with the mindset that you will succeed.. and remember, it is never pleasant for anyone, so don't feel bad. The end results are generally worth it!