NG tube- when is it not safe to send them home?

[anon456, BSN, RN]

Have you ever felt uncomfortable sending a patient home with an NG tube because there's no good way to verfy NG placement? The auscultation method is no longer considered safe and there have been practice alerts recently about it. (I'm writing a paper for my BSN studies and this has been on my mind).

Anyway . . so what if you get a patient ordered for discharge with NG, and there is no really good way for home verification. Let's say they are on continuous feeds and take a PPI (so pH may not work), and their neuro status is such that they would not show distress or coughing if the tube was in the airway. What then? Have you ever been in this situation where you had to challenge a doc about the discharge being unsafe? Or have you seen patients that were not sent home until they had a g-tube for this very reason?

I have not been in this situation yet but I can see it happening eventually with the types of patients we get sometimes. Would love to hear your experiences on this.

[flyersfan88]

Where I work, pts get PEG'd/j-tube/whatever if they are going to be on feeds long term/permanantly. I have yet to see this.

[AJJKRN]

Yep, my hospital would either have it ok'd to place a PEG or a PICC with follow up before DC'ing someone. One some very very rare occurrences, one of our Oncology GI surgeons has sutured a type of Dobhoff into a Pt's nose before but I have not ever sent a Pt home with an NG tube before...but then again we only do NG's for decompression where I work.

[Sun0408, ASN, RN]

I've never sent a pt home with an NGT. Never seen it happen either. Pts that need a long term tube are sent home after a peg or some type of j-tube was placed. Maybe someone from home health can better answer this question

[anon456, BSN, RN]

We routinely send babies home with them. Many times it's considered temporary due to needing to get bigger and stronger before a heart surgery, or just to buy them time to get strong enough to eat fully by mouth. The babies I have sent home have all been neurologically intact and would most likely react if it was misplaced. Still . . .

When I was a young mom my own child was sent home with home with one. I was not a nurse and I was scared to death of having it get into her lungs. The one time I put it in her lungs by accident I sure did know it right away, but really-- should we be teaching parents how to do this in the first place? I'm kinda rethinking a common practice as I'm writing this paper.

[KatieMI, BSN, MSN, RN]

There is a small device named "bridle" and it appears to work pretty good for displacements and especially for pulling out. But NO should not be left in place over two weeks anyway (local protocol) to prevent pressure ulcers in nasopharynx, so patient either has to get hard date of removing it or PEG or other similar device.

BTW, no PEG, Jtube, Dobhoff and anything else prevents aspiration 100%. It is inherent weak spot of the system, if you like, and there is nothing in our powers to guarantee it won't happen. Subsequently, applying all the measures known to prevent it indiscriminately (like keeping patient on his back 24/7 for weeks in a row with head always >30 degree, feeding him awful goop instead of tasty food, etc.) is exercise in futility which only can spoil the final result.

[anon456, BSN, RN]

There is a small device named "bridle" and it appears to work pretty good for displacements and especially for pulling out. But NO should not be left in place over two weeks anyway (local protocol) to prevent pressure ulcers in nasopharynx, so patient either has to get hard date of removing it or PEG or other similar device.

BTW, no PEG, Jtube, Dobhoff and anything else prevents aspiration 100%. It is inherent weak spot of the system, if you like, and there is nothing in our powers to guarantee it won't happen. Subsequently, applying all the measures known to prevent it indiscriminately (like keeping patient on his back 24/7 for weeks in a row with head always >30 degree, feeding him awful goop instead of tasty food, etc.) is exercise in futility which only can spoil the final result.

My own child and some of my patients have coughed or vomited them up and they are still in place on the nose, but the end is coming out the mouth. Some of our patients have had them for a very, very long time. Months and months. Either the parents refuse to get a GT or the docs still think the kid will eventually outgrow the need for a tube.

I agree that an NG tube should be very temporary, but it appears to be the culture in the infant-peds world to keep them in for a long time. I knew they were dangerous but the more I am researching the more I see how dangerous (the stats are pretty bad) and how hard it is to really verify their placement short of xrays.