NGT vs OGT in intubated patient, no sedation and AAO

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    Does your hospital have a protocol re: NGT vs OGT? In my hospital we routinely insert OGTs in orally intubated patients even if they are sedated. My mother was recently hospitalized and intubated. She lives far from me and when I arrived she was awake, calm, using yankour(sp?),etc. Her nurse told me they were going to insert an NGT for nutrition. I asked her to insert it orally since Mom was awake and didn't need trauma to nasal cavity. Nurse refused stating she had never heard of that. Finally called Sup. and Doc to get permission. Any thoughts?
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    Quote from treecy
    Does your hospital have a protocol re: NGT vs OGT? In my hospital we routinely insert OGTs in orally intubated patients even if they are sedated. My mother was recently hospitalized and intubated. She lives far from me and when I arrived she was awake, calm, using yankour(sp?),etc. Her nurse told me they were going to insert an NGT for nutrition. I asked her to insert it orally since Mom was awake and didn't need trauma to nasal cavity. Nurse refused stating she had never heard of that. Finally called Sup. and Doc to get permission. Any thoughts?
    If we were to place a tube for nutrition, we always did it nasally. She may not need to be intubated for that much longer, and an oral feeding tube while extubated is not exactly comfortable. Is the plan to extubate her soon and continue tube feeds? There is also the possibility of biting through the feeding tube when it is inserted orally...another reason to have it nasally when you are planning to have it for longer-term than simply decompressing the stomach.
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    Quote from heartICU
    If we were to place a tube for nutrition, we always did it nasally. She may not need to be intubated for that much longer, and an oral feeding tube while extubated is not exactly comfortable. Is the plan to extubate her soon and continue tube feeds? There is also the possibility of biting through the feeding tube when it is inserted orally...another reason to have it nasally when you are planning to have it for longer-term than simply decompressing the stomach.
    Pt intubated isn't going to bite through the feeding tube she would have to bite through the ett first. I think that it would probably be more comfortable with oral. Some MD's don't like oral tubes becuase they think that patient could pull it out, along with ett. My question is if she is alert enough to use a yankaure (sp) why is she still intubated, sounds like she could be extubated.
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    As it turned out, she was extubated and didn't need any tube. My point with the nurse was that she was AAO and cooperative. No restraints. The answer that she "never heard of that" concerned me. I understand your rationale that a patient may bite it, much as they do ET tubes. I also asked the nurse about using a Dobbhoff which, as you know is much smaller, but she kind of blew me off. I was just curious what happened at other facilities. I have done agency in places where they only use dobbhoffs for feeding and NGs for decompression. Generally, when we use OGs they are D/C'd when extubated and if there are nutrition issues we insert a dobbhoff.
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    I would do an OGT if there was not a chance of extubation in the near future or if she would most likely be able to meet her nutritional needs on her own after extubation. If there was a chance of extubation or an unlikely chance that she would be able to eat enough to have her nutritional needs met, I would place a kao feed tube nasally. I usually do OGTs on my patients (who are usually only intubated for <24 hours post cardiac surgery).
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    i put an og tube in a sedated/intubated batient the other day because i had so much trouble getting in through the nose. i felt like i was traumatizing the pts nose enough so finally i put down his throat. no one was available to help me at the time. the patient was intubated for about 5 days and then had to have a tiger tube place nasally, but he was awake enough to swallow. also while intubated, i think he was more comfortable having 2 tubes down his throat rather than ine down his throat and one up his nose.
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    We encourage oral tubes to nasal ones when the patient is intubated because the nasal ones can increase the patient's chance of getting a sinus infection. I probably would have inserted your mother's nasally because of her alertness and potential for extubation. If she was alert and awake enough, which it sounds like she was, I would ask her which she preferred. But, I have definately heard of, and mostly insert, oral gastric tubes.
    Easgaskins likes this.
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    The "never heard of it comment" would concern me as well. What was the big deal? Sometimes nurses make it harder on themselves by being defensive and fighting faimiles. Gees. If you don't know something, admit it and find out the answer. Sometimes nurses forget that they are there for the patient and it is not about themselves. Every question is not a personal attack on them.

    Doris
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    I beleive the latest studies encourage the insertion of OGT rather than NGT in intubated patients due to the increased risk of ventilator-associate-pneumonia. I think it has to do with passing the tube through all that germ-laden snot (as opposed to sterile mouths...right? )

    At my place of employemt we're encouraged to use OGT because of this....not policy...yet
    Easgaskins likes this.
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    We routinely place feeding tubes orally if they're orally intubated. It prevents traumatizing the nasal passages, and I would think if your mouth iis already held open by a BIG tube, you'd rather have a tiny tube taped to it than have an additional tube in your NOSE!
    Easgaskins likes this.


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