Quote from EricEnfermero
Are NJ tubes still standard practice in PICU? Over the last couple of years, our NICU has almost completely gotten away from NJ/ND tubes. It has been months since I inserted one. Just curious...
They will always be standard practice in our unit. Along with nursing our patients sitting up... and so stoned they can't cough. (We're probably Canada's largest purchasers of methadone
) We're very proactive about early enteral feeds (sometimes Day 1 post-op CV surgery if the kid's not on a lot of pressors) and since many of pur patients are intubated for weeks to months, this reduces our risk of aspiration dramatically.
I popped one into an 11 day old on Tuesday that was probably the easiest one I've ever done. Took less than two minutes from the naris to the jejunum. But I've also had some not-so-easy ones, like the older baby with heterotaxy. She wasn't my patient but I was the only certified nurse on that day. Her nurse was very new to the PICU and didn't know the significance of the organs being backwards, so she didn't think to tell me that the baby needed to be on her LEFT side. Poor baby, I had to give up after four attempts and three AXRs... that I didn't look at myself because the resident "was on it". She didn't think I needed to know the stomach curved to the left!
Anotehr stand out experience was a few weeks ago. Patient was a teenager with significant developmental delay and a hyperpactive gag. He was in the unit for aspiration pneumonia, an ileus that precipitated the emesis that led to the aspiration (of PEG... ewww!) and has a history of reflux, so we really didn't want to feed him NG. His dad refused to leave the room out of fear that something else horrible would happen to his son, and I was perhaps a little too confident of my skills. Because of the gag, I could only advance the tube about 3 inches at a time, then wait several minutes while he coughed, gagged and turned red. But the tube passed easily enough until I got almost to the final mark. Then I'd get resistance, back the tube out a few inches and try again. On the third try, suddenly the tube fillled with blood. I yanked it and watched in horror as he coughed, coughed again, coughed a third time and his ETT filled with blood. The coughing and gagging with an oral ETT in place had eroded a vessel in his throat and even though he had a cuffed tube, his coughing allowed the bleeding to leak down into his trachea. He recovered rapidly from this event, but the die was cast. Despite his extremely high risk of aspiration we fed him NG for two days before we got him extubated. He's completely recovered and home now. Thank heaven.