I am a nursing student and I will be graduating in May of '07. I am having a hard time with NG tube insertion. I haven't even done one myself yet, only assisted with some, and I have a really hard time watching the insertion, and sometimes I feel sick myself. Does anyone have any advice about how I can make it easier for myself? Are there others who felt this way at the beginning and then got used to it? Every time the patient gags I feel like I want to gag too. Last night I started to feel faint and it took everything in me not to leave the room. I even had a nightmare the other night about me having to get one. What to do?
Oct 26, '06
Sounds like you're working yourself up about one of the more simple tasks you will have to perform. Not that I'm for a moment belittling what you say but in the big picture of nursing tasks it isn't the hardest one you'll have to do. I'm sure in a few months you'll be laughing at how you felt about this.
Try going right back to basics by reviewing the A&P - not because you don't know it but to help you to try & make the procedure become a matter of mechanics & not feelings. Kudos to you for worrying for your patient but if it's done smoothly & quickly they are unlikely to have a major problem with it.
If the patient is allowed water then getting them to sip through a straw during insertion can help. Also make sure they are as upright as possible with their head tilted slightly forward if they are able to do so. If they are concious remember to ask them to swallow as the tube goes down, that helps to advance it, gets through the gagging stage quickly & helps it to go down the right way.
It might also be possible for you to ask if you can go to a stroke unit, or similar, where there are many NG insertions & then literally do one after the other until you're not worried anymore.
You can also try a relaxation technique such as counted breathing to help keep your mind on track.
I'm sure there will be other suggestions to come but all in all I think most people will say that you will get used to it & you will conquer your fear in the end!
Good luck xxxx
Oct 26, '06
Sometimes there are just things you have difficulty dealing with. Its not that uncommon. Yes you will need to try to get past it, and eventually you may be able to do it and wait until after to get that queasy feeling but it may never really go away.
On our unit when we have someone who has "issues" with a procedure sometimes we trade off. See if someone can do you a favor for a favor returned later. We have swapped patients on occasion to help a co-worker get past something that is difficult for them to deal with. Try to adjust to doing those tasks that you find difficult, because you DO need to be able to do them. But sometimes there are people around that will help you for help they need sometime. Just keep it in mind.
Oct 26, '06
I completely understand your fears. I've been a nurse for 10 years and have only inserted 3. One on an unconscious man who was intubated and the doc assured me that I could only go one place, the right place, since he was intubated. When the xray came, the doc said, "steph, come over here for a sec" and I walked over to see the end of the ng tube in his airway. So, yeah, it scares me that I will puncture a lung or something.
We don't do them very often - and I work part-time to boot so I don't get much practice.
I concur with the others, practice will make you feel proficient.
Oct 26, '06
Volunteer to do them early and often. RGN's suggestion about a stroke or even general Neuro unit is a good one. One patient is good for pulling his or hers out at least once a day on that type of floor. It is nervewracking, but if you do a few within a relatively short time span, you should feel more comfortable. It's better for you to do it now with your instructor than have to wing it by yourself later. This is one of those things that we just have to get a little thicker hide and do. There's no real way to make it any better for the patient except to get it over with as quickly as possible. If he/she can swallow it's better because there's less chance of it going in the airway. Always check the back of the throat with a flashlight when you're done. (Not a dinky, dim penlight, a real one. Most floors have at least one for inserting foleys into the deep,dark recesses of some women.) If you (and another set of eyes) can't see the tube, take it out. It's not in the esophagus. Remember the eshophagus sits flat in front of the airway. I dropped one in a pt's airway once and felt just awful. Pt was okay but
Oct 26, '06
You will be better able to control your own symptoms over time.
A surgeon taught me a great trick for inserting NG's. Along with all the other tips about sitting up, head bent slightly forward, sip water if able- ask the patient to keep their eyes open at all times. Have you ever seen anyone vomit with their eyes open? Doesn't happen. If they do this, it controls their retching and makes the insertion easier for them and for you.
Oct 26, '06
This was a task that I cringed at when I first graduated nursing school
. My first experience when I placed one was horrendously awful. But I tried. The next time it was easier. I always have to remember why the pt does need the ng tube. Usually the pt has had surgery or can't feed themselves or came back from endo with it. Thinking about why a pt needs it may help. A pt may need suction to keep from vomitting and a ng tube can help so the pt won't aspirate. Also I work in the CCU and most of the time we place OGT on intubated pts. Placing them on a sedated pt is less nerve racking since they aren't awake during placement. It helped me get technique down. It can be more difficult but it is a way to gain experience. It helped me overcome the nerves of possibly doing it wrong. Don't be afraid to ask for help and if you feel like you are going to pass out let someone know. Better to be embarrassed than hitting the floor. Besides most nurses don't want to call a code on a nurse that passed out.
Hopes this helps
Oct 29, '06
i realize that this would make the entire experience a whole lot worse for the student, but do the patients ever complain about having to endure such a nasty procedure a second time? this would also be true of foley catheter insertion or any other uncomfortable invasive procedure. how are patients selected which students administer to? if it were to happen to me i know that it would be simply devastating to have to have the patient complain. how do students deal with this? joe
Oct 30, '06
Placing NGs on concious pts is one of the less pleasent things you'll do as a nurse. Like the other posters said, remember that the pt needs the NG and try to do it as quickly as possible. This is the one thing I can't stress enough. One nurse I worked with that I was helping did it slowly and the tube hung a left coming down the esophagus and came out the pt's mouth! A little disconcerting for everyone involved let me tell you...
Whenever there's one being done, volunteer to do it. Once you get a few successfull ones under your belt it won't be such a big deal. Get someone you trust to help you with it, it'll make it much easier.
Oct 30, '06
I worked with a PA and watched him insert an NG and he did it so smooth I emulated him and have never had a problem. He use to say to the pt "I want you to stare into my eyes and don't lookaway touch your chin to your chest I am going to insert this tube into your nose when you feel it at the back of your throat I want you to just swallow while you keep looking at me but do not lift your head you can take some small sips of water if you wish". I tell you the procedure is so smooth. I honestly believe patient feel your fear which makes theirs worse.So look like you know what you are doing. Soon inserting them on a cooperative patient will be so easy that you can tackle the uncooperative violent pt who has overdosed.
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