question about ng insertion

[dayshiftnurse]

i need to build confidence with ng insertion. the other day, i "assisted" a junior nurse to get one in an older male pt. he was npo and was not able to follow commands to take a sip of water to guide the tube down. we were unsuccessful. a more senior nurse helped and she got it, unfortunately i was not in the room when she did it so wasn't able to see where we went wrong and how she seemed to do it so easily and gently.

i tried my best, but still the tube ended up curling into the patients mouth. i honestly can't really 'feel' the difference between nasally suctioning and ng placement, it doesn't feel different to me so far.

any tips would be helpful, this is a skill i really do need for my floor. thank you!!!!

[AnnieOaklyRN, BSN, RN, EMT-P]

Lots of lube. I find using lido jelly is helpful to decrease the pain and ease it down.

Chin to chest, makes the journey into the esophagus a more direct route.

Dont let the tube get to curly...

I know this patient was unable to follow commands anyway, but I find it causes less gagging when you just have the patient swallow without the water.

And remember after you first insert it in the nose to change your direction to posterior instead of upwards after you get it in the nares.

hope this helps.

Swtooth

[neneRN, BSN, RN]

Lots of lube, Cetacaine spray to numb, sometimes placing the tube in a bag of ice for a few minutes makes it a little stiffer and less likely to coil, if pt is unable to sip water then go slow and watch as they swallow; insert a little further each time they swallow, for some reason I've always had more success if I go for the nare farthest from me- maybe its a more natural angle, Ativan helps if pt is really anxious/tense...

[AtlantaRN, RN]

high fowlers, roll a towel behind the head (not the neck), so patient will be in a chin to chest position. best if you can put bed in a "chair position". I take the ng tube and just slightly bend the end so it's like at a 45 degree angle, then put it in tip down (it helps to make the curve at the back of the nasopharengeal area...that is usually where it will drag and it's uncomfortable.). If you are unsure if you are in the stomach (if stomach is full of junk, you will get a return of stomach contents, esp with stomach full), but if you are in the lung, it you put the end that is in your hand in a cup of water, bubbles will form when the patient exhales....i know the book says "litmus paper" to check for acid...because of stomach acid...

Good luck to you and practice, practice, practice. And don't get gun shy. Once I missed and went into the lung, and then I didn't want to try again for a couple of days. It's all about confidence.

And ALWAYS PAD the patients lap, because alot of times, it will make patients gag and vomit, and make a real mess......

Linda

[jewellpn66]

For patients who are on NG suction and NPO why are they not allowed to drink water:idea:

[suanna]

You are placing an NG- why does it matter if your patient drinks to promote the insertion- it's comming back out anyway! SIPPS are always OK. Ice the tube for 5-10min. Then, as ATLANTARN posted, bend the last 3inches or so to a 45deg angle. Insert with the bend down untill you get into the pharnyx. Now rotate the tube 180 degrees- I usualy turn medialy( clockwise L nostril, counterclockwise R nostril) and advance quickly but smoothly. Turning the tube points the tip away from the trachea- towards the back of the throat. If your patient swallows on instruction or spontaneously advance more quickly- then slow down.

[meownsmile, BSN, RN]

I agree, I was taught the 180 turn after initial insertion in the pharynx will promote avoiding the trachea.

[qpmz]

I have never tried it but a nursing instructor once told me sometimes if the pt can not swallow, but is in no danger of aspiration placing a small piece of ice on the tongue to melt and promote swallowing works.

[meownsmile, BSN, RN]

Anyone who cannot swallow is in danger of aspiration. That instructor is a nut and should know better than to introduce any liquid to a patient that cannot swallow unless you are in the process of suctioning.

[litbitblack, ASN, RN]

I think the main reason they are not allowed to drink water is the measurement of return on the suction. If they are drinking it and you don't know it then it will look like there is more drainage than there actually is they could have there tube in longer. Also its for decompression and drainage if there is a backup so you don't want to add to a problem your trying to fix