My charge nurse goofed

[delphine22]

On a cardiac PCU, new part time job, got a call from my charge nurse while I was in the middle of service recovery with a very difficult pt. "Help, my NG tube is clogged!" I knew she wasn't a new nurse, and I was trying not to leave the person in front of me, so I just told her over the phone, "Try coke." "I already put ginger ale in there, it's not helping!" "OK," I said, "let it sit in there a little longer and I'll be by soon to check it out."

I come to look and I see the problem: She had been infusing her meds into the air lumen. Now it's clogged, and filled with ginger ale on top of the clog.

The tube was for continuous feeding (the jevity was running fine in the gastric lumen), not suction. Honestly I've only taken care of about 10 NGTs in my career, we just dont' see them a lot in cardiac PCU, so I told her to check residuals religiously, keep trying to unclog, and to make sure to pass along in report what happened, in case anybody decides she needs suction at some point (or if they were planning on placing a PEG), I would assume a new tube would need to be dropped. The pt was combative, demented and in restraints with a sitter, dropping a new tube (especially as we were both inexperienced) wasn't an option that night.

Tried google but didn't really get any more info, what I told her was just my common sense advice. Obviously I don't think I'll ever see this again, but was that the right thing to say? Anything else I would have to watch for with that pt? (Hypothetically, she's long gone.) Don't know the hx but i think the feedings were for failure to thrive r/t dementia, not any sort of dysphagia or other condition, but I can't be sure. Thanks for your insight, GI nurses!

[elemenRN]

I'm kind of confused. Is this the standard NGT or the keofeed tube? Either way, I only ever use the "gastric" lumen that you described. We usually even connect a stop-cock to that for easier access. I use that lumen to suction back and check residuals, connect to continuous suction and to give the continuous feedings as well. Continuous feedings and continuous suction would never be ordered at the same time. If the "air" lumen (which I don't think I've ever seen?) is clogged with medications then the patient did not receive them. That's the only real problem I can see in this scenario. Checking residuals more than what is ordered is kind of unnecessary as the clog won't permit the feedings to pass and high residuals aren't technically possible. If that was the case any way, your pump would certainly alarm you of the clog! And just as a side note, carbonated beverages are seemingly great for GI tubes. I did hear from one company representative, however, that carbonated beverages can be damaging to the plastic of the tubes. Not sure how accurate that is, I just try to avoid it now out of fear! Good luck, I hope that helped a little bit!

[Ruby Vee, BSN]

Sounds like you were using a Salem sump for feedings and she tried to force meds through the air vent? Now you have a clogged air vent and the patient didn't get those meds. Hope someone notified the provider about that. You're right -- if you ever want to use it for suction again, you'll have to drop a new tube. I've had some luck de-clogging with meat tenderizer, but good old fashioned muscle is required to force it in far enough to do any good. "Clog Zapper" works, too -- if you can force it in past the clog.

Hopefully she learned her lesson about the air vent, and won't try that again!