Inserting an NG tube post arrest

[abidingpanda]

I am a new nurse and I work in the emergency department. One of the things we do at my facility with a post arrest after we RSI the pt, establish IV access, and start drips is insertion of an NG tube. I cannot seem to figure out how to get the tube in to the stomach on an unconscious pt!!! I have no issues when the pt is alert, sitting up, and sipping water, but the tube coils in their mouth every time if they're unconscious. I've tried bringing the chin to the chest, and leaving the pt's head flat on the cot, and 9/10 times it coils in places besides the stomach. I have also tried using more lube, smaller tubes, and different nares. Any tips?

[Julesmama28]

Why not use an OG? That's what we do with intubated patients.

[Penelope_Pitstop, BSN, RN]

Why not use an OG? That's what we do with intubated patients.

Seconded.

The ETT makes for a nice trail for the OGT. Takes two seconds.

I'd ask a senior nurse why your protocol is this way.

[MunoRN, RN]

I prefer OG in an intubated patient, there's more potential trauma with have tube down the nostril for an extended period of time. If you're intent on placing an an NG in an intubated patient right after paralytics were used you're going have difficulty with the tongue blocking the route from the nasopharynx on down. Sit the patient bold upright, chin down and thrust forward, that's the only way you'll avoid it coiling in the mouth. But again, it's far easier just to go through the mouth and use the natural curvature at the back of the mouth to guide it down the esophagus.

[ScrappytheCoco]

It's been a while but I did a paper on nursing school about research leaning toward ng over og in an intubated pt. Something about not having to retube once they're extubated if they still need the tube for gastric concerns. I get that...but in the real world we usually do OG and I've never had a problem passing one.

[Dranger]

If the patient is tubed there is no reason NOT to use an OG and then tape it to the ETT.

[Lev, MSN, RN, NP]

Many times the larger tubes are easier to get in. We go for OGT first and then NGT if unsuccessful.

[Dranger]

It's been a while but I did a paper on nursing school about research leaning toward ng over og in an intubated pt. Something about not having to retube once they're extubated if they still need the tube for gastric concerns. I get that...but in the real world we usually do OG and I've never had a problem passing one.

Realistically, if this person arrested they are going to be intubated for at least a day or so (depending on length of arrest, hypothermia therapy etc etc). During that time a dobbhoff will most likely be placed anyway. In an ED setting, an OG is completely appropriate,

[AnnieOaklyRN, BSN, RN, EMT-P]

You should be doing OG on intubated patents. If I recall correctly NG tubes increase the chance of VAP.

Annie

[blondy2061h, MSN, RN]

Realistically, if this person arrested they are going to be intubated for at least a day or so (depending on length of arrest, hypothermia therapy etc etc). During that time a dobbhoff will most likely be placed anyway. In an ED setting, an OG is completely appropriate,

Realistically, if the patient arrested, ENT can just place a PEG when they place the trach in a few weeks.

[CryssyD]

Agree with MunoRN. Lift the patient's head up when first passing the tube--I don't know why, but it seems to help.

OG is better for long-term, definitely, but NG's are acceptable for intubated patients. Sometimes a bit of wiggle when hitting the curve inside the nares helps.

[Dranger]

Realistically, if the patient arrested, ENT can just place a PEG when they place the trach in a few weeks.

Realistically, they should just go to comfort care and not torture the brain dead soul for the rest of their life. I always get angry when I see PEG/Trach with individuals who will never come back.

I have also had lots of arrests get extubated rather soon, just depends on how long they were down for.