Baffled over what happened w/my pt's NG tube insertion...

  1. [font=impact][font=book antiqua]i can't stop thinking about what happened w/my 29 week pt. this morning. i tried to insert an ng tube with the expectation to start feeds. when i attempted to insert, i got to a point whereby the tube would not advance. it stopped at that same point with every attempt. i taped the tube at that point, obtained xray and it turned out that the tube was in the right main stem bronchus. does anyone know why this may have happened? the tube ended up in that same place with every attempt. is this a sign of something? any similar experiences?
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  2. 10 Comments

  3. by   dawngloves
    It happens. That's why you have to ausciltate after placement. We also use pH paper to check secretions.
  4. by   Hannahrn
    I realize that the tube may inadvertently advance into the trachea rather than the esophagus. Keeping in mind how difficult it is to intubate a patient's trachea...I guess I didn't provide enough details: we (myself and another RN) re-inserted the tube 5 TIMES and intubated the trachea every single time. This was using an NGT with a stylet. The chances of intubating the trachea without the use of a laryngoscope is so slim! I guess what I am worried about is...could the child have some deformity of the trachea/esophagus OR could I have perforated the esophagus on my first attempt thereby forcing the tube into the R mainstem? WHat are your thoughts and has this situation ever happened to anyone else? Thanks
  5. by   Jolie
    Quote from Hannahrn
    I realize that the tube may inadvertently advance into the trachea rather than the esophagus. Keeping in mind how difficult it is to intubate a patient's trachea...I guess I didn't provide enough details: we (myself and another RN) re-inserted the tube 5 TIMES and intubated the trachea every single time. This was using an NGT with a stylet. The chances of intubating the trachea without the use of a laryngoscope is so slim! I guess what I am worried about is...could the child have some deformity of the trachea/esophagus OR could I have perforated the esophagus on my first attempt thereby forcing the tube into the R mainstem? WHat are your thoughts and has this situation ever happened to anyone else? Thanks

    I've been out of the NICU for a while, but I've never heard of inserting an NG tube with a stylet. Is this a regular feeding tube?

    I do recall placing a feeding tube into the trachea once. The baby coughed and sputtered and cried a very hoarse cry. It was obvious that the tube was misplaced, and I removed it immediately.

    I suppose that your baby could possibly have a T-E fistula which would make mis-placing the NG tube more likely. But you raise an important point about always checking the placement of an NG tube.
  6. by   dawngloves
    Stylet? What size tube is this? Was it the first NG tube this baby had?
    Hmmm....Like Jolie, I can't think of anything anatomical that would force a tube into the right mainstem other than a TEF.But there'd be other evidence of that.
  7. by   Gompers
    I have also never heard of using a stylet for NG insertion, in babies or adults. Thinking anatomically, maybe because the NG tube was so straight, it couldn't slide into the esophagus and instead went straight down the trachea? Usually with a normal NG tube (no stylet) it just naturally goes into the esophagus. Though I know it happens, I've never had one go into the lungs. I've also taught parents how to do it, and they always get it into the esophagus on the first attempt. It's gotta be the stylet.

    What size NG was it? We typically use 5fr for <1000 grams, 6.5fr for 1000-2500 grams, and 8fr for anything over that size.

    If the NG still won't go down to the stomach without a stylet, trying both nares and the mouth...then definitely needs a workup for TEF.
  8. by   unikuelady
    We use stylets with the very soft yellow 5fr long term feeding tubes. So far I havent had any problem inserting one.
  9. by   unikuelady
    When I say stylet, I don't mean the rigid ones use in et tubes, these stylets are thin flexible wire to maintain just enough rigidity in the soft ng tube for insertion.
  10. by   BittyBabyGrower
    Jolie...we had a kid that kept aspirating, the ng going the wrong way, etc for about a month...he had multiple swallows, studies and then one day it showed a TEF...the flap was only evident when the kid threw up during a Ba swallow! He had no other symptoms!
  11. by   Hannahrn
    we use #5 french nasogastric tubes (the brand name is corpak). they are for long term use, you do not need to change it but once every 30 days. we use the same size, 5 fr., for every baby wether they are 25 weeks or 35 weeks, etc. they are very soft/pliable which is why a guidewire (stylet) is used to insert them.
  12. by   Hannahrn
    [font=franklin gothic medium]by the way, thanks for all the input so far...

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