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?

[ProgressiveActivist, BSN, RN]

TH patients are not fed. The ogt is needed upon intubation to relieve gastric distention and prevent aspiration.

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

[Penelope_Pitstop, BSN, RN]

TH patients are not fed. The ogt is needed upon intubation to relieve gastric distention and prevent aspiration.

They're not fed when they're cold, that's true. But most post arrests when warmed are then fed as we play the "will they/won't they" game in regards to trach/PEG. OGTs can also be used for med administration.

Although...ENT placing PEG? We always had general surgery come to the unit and do it at the same time as the trach.

[Oh'Ello, BSN, RN]

I never really "neck tilt" with intubated patients. If I'm having trouble, I elevate the head of the bed (which can be tricky hemodynamically with post-arrests sometimes), and then depress the base of the tongue with a depressor and slide that NGT right in.

[ProgressiveActivist, BSN, RN]

Although...ENT placing PEG? We always had general surgery come to the unit and do it at the same time as the trach.

I never said that they did.

You need to take it up with the poster who wrote that.

[Penelope_Pitstop, BSN, RN]

I never said that they did.

You need to take it up with the poster who wrote that.

I know you didn't say that. And I have no issue with it if it happens, I've just never seen it happen and was curious.

Gawrsh.

[cjcsoon2bnp, MSN, RN, NP]

I am glad that the OP asked this question.

I too struggle with placing an OG tube (or NG) post-intubation, every time I do it the tube curls in the mouth and won't go down into the esophagus. I try and trace/follow the ET tube, change the position of the bed, lift the patient's head and use a yankauer tub to move the tongue (a suggestion that one of my coworkers provided me) and I still just don't seem to get it right. Interestingly, in a conscious and cooperative patient I have been able to drop an NG successfully every time I have done it but in those post-arrest, intubated patients I struggle. Even with all of those tips I can still only do it correctly in about 25% of my attempts but all you can do is try to practice the skill whenever possible with the guidance of a more senior nurse. One thing to keep in mind is that there are certain skills that won't be your strong suit no matter how much you do it, you just have to try and practice at every opportunity and ask for the help of a coworker if it doesn't work out. Sometimes you might have to trade off on a task with someone who is better suited for it and vice versa when it is a task in which you are skilled.

!Chris

[canigraduate]

Couple of points:

1) A PEG doesn't have to be for feeds, it can be for decompression and aspiration prevention. My grandma had one for that reason after hiatal hernia surgery.

2) Positioning is everything. Try to visualize the anatomy and where the ETT is. If your OG/NG is curling, it's because you're getting stuck on the tube or on the back of the tongue. You need to get the obstacles out of the way. Think about obstructive sleep apnea and how it occludes the airway. If possible, sit the patient up or tilt the head back once you get past the nasal cavity.

3) One trick that works for me is the fill the tube with water so it's stiffer and doesn't curl as easily. Another one is to get a tongue depressor and physically push the tip of the tube to the back of the tongue as you're advancing so it goes down and not out. A third is to use the curvature of the tube as a stabilizer. Think of inserting an oral airway and how you twist it to get it in right - do the same thing with your NG once you pass the sinuses.

The only time I've ever NOT gotten an NG tube into place is when the patient interferes. It's easier when they're out cold and have to keep their hands to themselves.

[canigraduate]

I never said that they did.

You need to take it up with the poster who wrote that.

You're particularly confrontational lately. Hope things are going OK for you.

[meanmaryjean, DNP, RN]

My suggestion (and this has always worked for me) is to not use too delicate a touch. Everything's limp and relaxed post-arrest. You have to kind of cram that tube down, FAST!

[SubSippi]

Twist the tube between your fingers a little bit the whole way down, not just when you're trying to get over the hump. It'll help the tube glide down past the tongue instead of getting caught in the mouth.

[ProgressiveActivist, BSN, RN]

Yes, I confronted a false statement addressed to me with a fact. Not to provoke an argument but to prevent one.

You're particularly confrontational lately. Hope things are going OK for you.

[twozer0, NP]

We never did NG only OG tubes for any patient smoking plastic. I have seen the NG done and on sedated patients, i have no qualms about risking limb by sticking my fingers in the mouth to align the tube with the ET tube and push. Usually the hangup is in the back of the throat and it can be manipulated manually. Easier solution? OG!