Nebulised lignocaine for NG insertion

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Does anyone use nebulised lignocaine (or equivalent) when inserting NGs? The place I work now does but nowhere I've worked before has and I'm a bit unsure of it. I know there is a study or two which (allegedly) concluded that it decreases pain and distress due to NG insertion in adults (in kids the nebuliser caused so much distress it wasn't worth it) but I can't find any studies on whether it increases the risk of complication such as the NG entering the airway. If a patient has the lignocaine they lose their ability to swallow and protect their airway properly and they can't have water to sip when the tube is going down and if the NG insertion fails they can;t drink for hours after. I think if I was a patient I would pick a short duration of discomfort over an increased risk of aspiration.

Does anyone know much about this? I would love to hear what other nurses do and think.

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Specializes in Nephrology, Cardiology, ER, ICU.

Hi and welcome. I'm assuming you are saying "nebulized lidocaine"? Here are some references:

Tips From Other Journals - American Family Physician

http://prc.coh.org/FF%20Intranasal-A3-11.pdf

Does nebulized lidocaine reduce the pain and distress of nasogastri... - PubMed - NCBI

Hope this is what you are looking for...

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Can anyone link me to a full-text study related to use in the adult population? I'm interested!

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No I meant lignocaine... and wrote 'or equivalent' because I don't know what the Northern Hemisphere uses. I'm from Australia where we have paracetamol and adrenaline not acetaminophen and epinephrine so I never know whats the same and what different! To my knowledge, lignocaine and lidocaine are pretty similar if not the same so what applies to one should apply to the other.

Thanks for the links, the third is one I have read before which clearly advises against it's use in children but the second one form UW Health recommends it's use in children and I can't believe it advises that you give them water even after having the lido/lignocaine! It even says they may lose the ability to swallow and with cough and splutter...this sound like a huge aspiration risk to me. The first article is very interesting, I didn't know it increased the risk of epistaxis. I wonder if this group was given water to sip? It's a pretty small study... I wish someone would do a large RCT as I'm still pretty uncomfortable with it's use.

TraumaRU and proudblood do you use it? What are your opinions after seeing these links?

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From what I can ascertain, lignocaine and lidocaine are one in the same. I do not use it nor am I familiar with it being used in New York State. That doesn't mean it's not happening. Anecdotally, it sounds like a great idea and I'd be interested to learn more if anyone can point me in any additional directions.

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Specializes in ER.

I've used it. It numbs their whole face and it takes ten minutes for the neb to run through. I prefer to use the endotracheal spray lidocaine, two shots to the back of the throat and two in whatever nare you are going to use. It lasts about ten minutes.

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We do not use nebulized lido for anything that I know of -- our providers tend to use hurricane spray for NG insertion. Works very well!

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From my experience, it should be the standard of care just as it should be for urinary catheters.

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I wish it was standard -- I have yet to see a foley kit come stocked with it, and finding the sterile lido jelly "jets" are almost impossible unless you're from Urology.

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I wish it was standard -- I have yet to see a foley kit come stocked with it, and finding the sterile lido jelly "jets" are almost impossible unless you're from Urology.
And in order to be effective, you need to instill it and then leave it in for 20-30 mins prior to placing the Foley.
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I just put in my first NG the other day. I asked the physician about his preference as my supervisor said I should ask for something for anxiety such as ativan. He said he would use hurricane spray, but to see what the pt would prefer. Ended up just giving morphine for his pain from the obstruction and that was good enough to get the tube down as well. It went down with no complications, no complaint from the pt besides discomfort of feeling the tube in his throat. Since that was my first one, are all times not as easy as that? I've had a scope in and down my nasal cavity when ENT was looking for nasal polyps and it wasn't too uncomfortable.

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