Nebulised lignocaine for NG insertion

[nixonk86]

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.

Since that was my first one, are all times not as easy as that?

No, sometimes they're very difficult to pass due to the patient's anatomy, injury, or discomfort.

[NickiLaughs, ADN, BSN, RN]

It's much more difficult when they try to push you away

I've used the lido neb before, seemed to help, but usually when they're that anxious about the tube, it's difficult to get it down period.

[canoehead, BSN, RN]

I've had better luck when I tell the patient beforehand that they are going to want to rip the tube out as I'm putting it in, that they may cough, but if they say "stop" we will stop right where we are until they give the OK to go ahead again. Then follow their wishes religiously. Most people make a "stop" request, but once they realize they are in control, they seem to be calmer, and will swallow the tube down with water with much greater ease. Plus, I haven't made a lifetime enemy, which feels much better.

[icuRNmaggie, BSN, RN]

In the U.S., hospitals have strict policies about what meds can be given by the inhaled or nebulized route. I have not given nebulized lidocaine and I can not, because doing so would be a violation of hospital policy.