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Can we talk about NG/OG tubes?

Posted

I have recently had patients that I have questioned the safety of NG tube placement. Are they certain diagnosis/history/symptoms/labs that flag you that NG tube is a bad idea? For example - alcoholic patient with critical H&H...

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

It would be a bad idea in a pt vomiting bright red blood as if could be and most likely is from varices, especially if the patient is hemodynamically unstable. You do not want to rupture one of those varices. I would not do it until the pt had had been seen by GI.

GI will always pull the NGT to do an EGD so is it really necessary? I think not.

If just vomiting old blood or coffee grounds I would insert it.

An actively bleeding gastric ulcer would have a collection of " fluid" on CT scan. The usefulness of the NGT with an active gastric bleed is knowing the amount of blood loss. This is a surgical emergency.

BecomingNursey

Specializes in Emergency Nursing.

Previous brain surgery is a red flag. If the membrane between the nasal passage and the brain the ng tube could pass into the brain. Head/facial trauma is also considered a red flag.

That alcoholic patient is absolutely in need of an ngt. It is needed for gastric lavage, to ensure that this is an upper GI bleed. Ngts should not be placed in patients who have a fresh gastric surgery, or patients with the possibility of a skull base fracture.

MassED, BSN, RN

Specializes in ER. Has 15 years experience.

never an NG with Varices or known varices, or potential varices. Never never.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

The GI docs will have the nurse lavage until clear with cool water for coffee ground drainage. That is so that they have a clear view of the stomach during the EGD. If time permits I will do it but it is not a top priority.

I am not talking about decompression for an obstruction.

If an NGT was placed in the OR post gastric surgery, it is placed to LIS, the air vent should whistling, placed above the heart and sumped every four hours with 20cc of air. Know exactly where it was placed. I mark it with a sharpie.

Edited by icuRNmaggie

K+MgSO4, BSN

Specializes in Surgical, quality,management. Has 12 years experience.

I will not drop one on someone eho has had a gastrectomy or partial gastrectomy or a gastric sleeve etc. Due to anatomical disturbance. The UGIHB team can do it under scope guideance or fluro. As others have said bright red blood. This is a surgical emergency. Coffee grounds no I will wait till the blood results come back. Facial/ head trauma brain surgery some rhinoplasty cases.

Saying all that I am the queen of the NG for decompression, one of my consultants thinks I am meaner than him regarding dropping them early. However as I tell him, 5 am is not the time I would want one in after vomiting faceal matter all night long. In early, out at good flatus or bowel action and walk, walk, walk.

never an NG with Varices or known varices, or potential varices. Never never.

What about if the patient goes into resp arrest and we have to intubate, we drop OGs on intubated pts. This patient was in endo getting a procedure done for esophageal varices when he arrested.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

The endo patient may have coded when the varice was ruptured with the scope. Those patients hemorrhage, brady down immediately and usually require the massive transfusion protocol. I would not tempt fate by putting in an OGT. I would be on the phone to the GI doctor for specific orders to hold the OGT or to say I am not comfortable doing that and I would put the conversation in my notes.

Edited by icuRNmaggie

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

Esophageal cancer is another situation in which I have have refused to attempt NGT placement.