a few clinical practice questions

[pedsnrs]

I'm new to the site-been a peds nurse on an infant unit for about 2 years-i'm looking for feedback on practices in other childrens hospitals.does anyone routinely give chloral hydrate for sedation of infants for procedures?what is your monitoring protocol for this? also, what is your procedure for verifying placement of feeding(ng)tubes? just curious,wanting to compare.i'd appreciate feedback,enjoy this site very much!!thanks!

[moliuchick, RN]

We use ng or og tubes for feeding. It depends on the baby, whether or not they are starting to nipple.We do auscultate for placement, but also aspirate for residuals. When a tube is too high, it doesn't feel right when I aspirate. I've had nurses tell me they've had no residuals all day, and after I've checked placement, and pushed the tube in another cm or two, I get several cc's back. We have cm marks on the tubes, which also helps with correct placement. When we've had xrays done with the tube in place, I'm usually right on. We would never specifically check placement with an xray, though.

We do use Chloral hydrate on Peds for sedation. I've seen it work very well, and I've seen it not touch the kid. We put CR and sat monitors on and do frequent vitals.

:imbar

Okay here is my ambarrassing experience with the feeding tube.

My instructor and I had to pour some crushed med down the pt's tube.

I asked her several times if the med was crushed small enough and she said it would be okay but when we started pouring the stuff in nothing went thru.

Then it went to a point that she pushed the plunger so hard that all the med and water came splashing on the pt's face. I felt so bad.

Then we ended up having my nurse to do it for me. I saw him kind of diluting the med with warm water first then he aspired the med and water from the container (so the plunger was in for the whole time) Not like when we did it, we didn't put the plunger in until we plugged the tip of the syringe into the tube. He also shake the syringe side way to let the smaller particles run down the tube better.

Does anyone know of any good video or websites that will show how exactly I should do with NG feeding and drug admin? I am worry about doing it again next time b/c it looks like you have to be a a genious to know how to do it!

[goats'r'us, ASN, RN]

hey, i'm just a kid, but my clinical teacher gave us a talk on NGTs and stuff, and said the best way to tell is chest xray. other ways include aspirating it and auscultating it. there were more, but i forget..

[RN_Amy, RN]

do they really do an xray each time before a med or an intermittent bolus feed (for example) would be given?

Sorry... my post was rather ambiguous... just need an xray after initial placement of the NGT...