need tips for easier NG placement

Da_Milk_of_Amnesia, MSN · Feb 21, 2010

What is the issue you are facing?

snoopy29 · Feb 21, 2010

For me the key has always been patience. Lots of people don't like passing NG's and try to get them in as quick as possible which results in a patient gagging and with eyes streaming.

I get everything close to hand have a chat with my patient and explain it is going to be unpleasant but if they can work with me when the tube is in they will feel so much more comfortable. I put the NG in iced water so it is more rigid and use loads of lubrication. When the tube hits the back of the throat i get the patient to swallow iced water so they are swallowing the tube rather than it just being pushed down, before advancing I always check it's not curled up at the back of the mouth.

It's so easy to say but the key issue seems to be confidence, when I was training in the dark ages every single patient seemed to have an NG so I got loads of practice in the early days. I have a friend who is a senior nurse in A and E and despite spending some years in the department has yet to successfully pass an NG and by her own admission says this is because it has become such a big issue in her head.

Anyway good luck with it and lots of respect for getting your head around the rest of the job :)

OldnurseRN · Feb 21, 2010

Sometimes placing a nasal trumpet first then passing the tube through that will work easily.

core0 · Feb 21, 2010

Started ER as a new grad 8 months ago. I have gotten over my fear of most things-- but NGs still make me want to bolt out the back door.
I have tried it with the nebulized lido, with urojets, sips of ice cold water and still the experience is horrible for me and my patient.
I still grab a more seasoned nurse to accompany me, they tell me that NGs are just like that.
Any good tips to make me not want to run away when I realize I have a patient with small bowel obstruction and the NG order is just looming in the distance?
(oh-- and I hate the phrase "can you go drop an NG in bed 3?-- makes it sound like it is as easy as dropping it on the floor and not similar to waterboarding)

Take a look at this. Its a pretty comprehensive guide to NGs:

http://www.icufaqs.org/NGtubes.doc

For that matter the whole site is pretty good (not just for the ICU):

http://www.icufaqs.org/

A couple of tips that I have found helpful. Put the patient with their chin toward their chest (lets the NG slide along the back of the throat. If you can coat the NG with viscous lidocaine and spray the throat with Hurricaine or something similar (never tried lidocaine nebs). Dip the tip in ice water to give it some stiffness. Then curve it a little bit so it follows the natural curve of the nasal passage. Finally give the patient a cup of water with a straw. As you pass the NG have them take a drink (which closes the eppiglottis).

David Carpenter, PA-C

albedo · Feb 21, 2010

Hi I am a first semester student. I have always wondered how what I've learned about NG tube insertion is gonna work on real people because we don't get to practice on real people. But when I compare what I've learned and what I've seen in hospital when a nurse was trying to insert the tube down into my friend's throat, I really want to see if mine would work better (that nurse completely failed).

I've learned that we have to soften the tube. Mark from nose tip to earlobe and from earlobe to xiphoid process on the tube. Tilt the pt's head back a little bit. Insert until the pt starts gagging and reach the first mark on tube. Then have the pt's chin touching his chest and have him taking sips of water and advance the tube. Stop when he breathes.

Is this method working in real life?

Editorial Team / Moderator · Feb 22, 2010

I do it as core0 outlines above, and I've been mostly successful with them. Another tip -- I have the patient sit on his/her hands. Their first impulse is going to be to grab that tube!

HRM672 · Feb 22, 2010

It's funny for me to read this thread because I drop NG tubes every day...but usually only on babies or toddlers. It sounds so much harder on an adult! Thanks for all of the interesting tips I can use with my next teen or older child.

K+MgSO4, BSN · Feb 22, 2010

always take an assistant with you of some shape or form to hold the pts hands and help them sip the water from the straw. The first one I did I got myself more worked up about it than the pt resulting in her not being able to understand my explanation but a very seasoned HCA explained what was going to happen.

I am a colorectal/hepatobillary nurse so I flick one in at least once a week as our ED seems to never do them before sending the pt up to the ward just load them up on anti emetics!! Will not help when you are vomiting faecal matter!!

Part of my explaination is always "this is going to be horrible, you may try and punch me or grab my hands but it is better in the long run than vomitting up poo...........that can't taste nice!

Just take a big breath and tell yourself it is a little bit of pain you are inflicting for a longer term comfort! Just like an IM or starting an IV but it's looking at a NG tube and to know where it has to go gets many nurses freaked out!

You'll get there - xoxo

JustJen, BSN, RN · Feb 22, 2010

As a right handed person, I find that if there are no contraindications, standing on the patients right side while inserting into the left nare is my most sucessful "side". I can use the right nare, but for whatever reason, the left is always an easier insertion for me (and my patient)

I_LOVE_TRAUMA, RN · Feb 24, 2010

I see some like to dip the tube in ice water to make the tube more rigid. I like to do the opposite. I soak the tube in hot water for a few minutes, makes it like a wet noodle & it will slide right down And just like everything else, it will get much easier with time...

Virgo_RN, BSN, RN · Feb 25, 2010

They do get easier. You've gotten some great advice. Good luck!