Difficulty Aspirating NG Tube

[rachelgeorgina]

I am hoping someone can shed some light on this. I've not worked a lot with NG tubes before (I typically work with profoundly disabled kids who have G tubes) however I've come into a situation where NG tubes are more commonplace and I'm having a bit of trouble with them, even after reading all my texts and speaking with my educator etc.

In particular I'm having trouble aspirating stomach contents via an NG tube. When I pull back on a tube with a syringe the syringe will typically come up empty, with just air in it. If I flush the tube with 10mL of fluid and then pull back I can get the same fluid back (typically about 3/4 of it) with what looks like some feed in it - but I can't get pure gastric contents on plain aspiration.

Where have I gone wrong? Can any point point me in the right direction or in the direction of some useful literature. My texts are failing me on this one!

[CVmursenary]

keep pulling back slowly with alot of force, it requires alot of reverse pressure to pull the contents up so you have to pull hard and it may come up slowly.

[rachelgeorgina]

Thanks Brandon. What size syringe would you suggest? & can you explain how to pull back with a lot of force? Would that involve using a larger syringe or injecting air or something else that I might be missing? Because I'm not sure how to apply more force when I am pulling back on a syringe that's not giving me any trouble.

[CVmursenary]

50 or 100cc should do it, and i say pull harder because there should be some resistance when you pull back on the syringe.

[GM2RN]

Sounds to me like the tube isn't advanced far enough OR you may be in a lung. Make sure you are measuring correctly AND verify placement with an air bolus first. If you still get air initially, try advancing the tube in small increments until you get stomach contents before pushing fluid. I'd be suspicious that the tube is not placed correctly if all you are getting back is plain water.

Edit: I'd be careful of pulling back with "a lot of force." I'd say pull firmly but gently. It really shouldn't take much force to get enough contents to know you are in the stomach.

[LouisVRN, RN]

It is EBP to not use an air bolus to auscultate, at our facility the rule is if you can not aspirate gastric contents you need to get a physician's order for an X-ray for placement before it can be used. I have only had this happen once and it was the other night, per the physician's order we set the returned fluid (after flushing the NG tube and withdrawing the saline) to the lab and it was acidic enough to be considered gastric contents.

[GM2RN]

It is EBP to not use an air bolus to auscultate, at our facility the rule is if you can not aspirate gastric contents you need to get a physician's order for an X-ray for placement before it can be used. I have only had this happen once and it was the other night, per the physician's order we set the returned fluid (after flushing the NG tube and withdrawing the saline) to the lab and it was acidic enough to be considered gastric contents.

It is EBP not to use an air bolus as the ONLY method of verification. It is fine when used in combination with checking the appearance of aspirate, pH of aspirate, and/or xray. However, xrays can and have been misread, so they should not be used as the only method for verification either.

[noyesno, MSN, APRN, NP]

I considered writing my research paper (for school) on "the best method to check for NG tube placement" but went with a different topic. During my initial research of this topic though, I found the best method for checking placement (aside from X-ray verification) was aspirating gastric contents and checking the pH of this fluid.

So, last week in clinical when I was unable to aspirate any gastric content through my patient's NG tube, I did not did not feel comfortable using the air bolus auscultation method because the research gave me the impression it wasn't that accurate. I called my preceptor into the room and to my surprise, she went right ahead and auscultated an air bolus and instructed me to proceed with administering medications through the NG tube.

I followed her instructions but was very uneasy about it. I would have rather gotten a X-ray order like they do at LouisVRN's place of employment.

[nursing6207]

I'd say advance the tube a little further. I have had just air return before and as soon as I pushed it a little further down I got green gastric content. I would document verification by auscultation and aspiration of gastric contents. Good luck.

[jnrRN]

Basically as everyone else has said it is probably not in the right place (hopefully not in a lung) so get a check on that ASAP!

And in regards to aspirating, it really shouldn't be too hard. Sometimes you do have to pull back a few syringes of air to get just a tiny little bit of juices but I suppose that would depend on how recently this patient has had a feed.

[Da_Milk_of_Amnesia, MSN]

Being in ICU we use NGT/OGT ALOT. One thing is that you should NOT have to pull back with alot of force, you can hurt the lining of the stomach. It should be a very easy pull back if there is any gastric contents. Secondly, If I can't get return sometimes all it takes is a little advancing or pulling back on the tube to get return. If you can't get anything or do not trust it, SEND IT TO THE LAB for them to check or if you have litmus paper on the unit then use it. Usually what we see when we place NGT/OGTs is that they coil up in the stomach so pulling back usually does the trick.

[nurse2033, MSN, RN]

If the NG is inserted too far it can curl up so the distal end it pointed upward. If the stomach doesn't have much fluid in it you won't get much of a fluid return. Many times if I feel this has happened I will pull back on the tube a few inches and the distal end will drop down into the pool of fluid at the bottom of the stomach where it is supposed to be. Measuring carefully before starting will help a lot.