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)
This is what I do.... barring any med allergies.. I take qtips and dip them in viscous lidocaine and put them in the nose for about 5 mins. I spray the back of the throat with cetacaine. I lubricate the tube with viscous lidocaine. I look up both nares, ask if the pt has ever had a broken nose or deviated septum. I pick the biggest one and SLOWLY insert the tube, oh and I curve the end of the tube so that it goes into the naso-pharynx more easily. Go in until the measured spot and listen with the stethescope as I inject air then tape it into place if it's in the right spot. Hope this helps.
As above - lido, lido, lido! I guess I do all the "numbing" prep I can... then I have at LEAST one other person with me, usually the techs because they seem more helpful and experienced as an "NG assistant" than some of the nurses I work with. I get the tube out and wrap it around my hand to get it loose and limber... and it gives a little curve to the insertion end. I try to use a light to look in the nose and see where I'm going -- all the preparation you have helps things go smoother. Good luck!!!
That was new to me!! The tube already holds its shape easily! Well except for those baby NG tubes, I've started IVs in adults a larger size than those!
I'm the opposite.... I soak the end of it in warm water while I'm getting the rest of the prep ready to make it more pliable so that it can more easily bend it's way thru the nasal canal, down the throat, etc..
I have found that the use of a topical nasal spray about 5-15 minutes before NGT insertion, such as Afrin or Neo-Synephrine helps shrink the nasal mucous membranes, aids insertion & minimizes the risk of nose bleeds from the procedure. I also see a lot of folks want to guide the NGT up "aiming" towards the top of the head. Instead, you want the tube to go straight back towards the pt's Occiput along the bottom of the nasopharynx. Good luck the more you do & are successful at, the more confident you will become.
Specializes in Emergency/Trauma/Critical Care Nursing.
I'm surprised that Sassa was the only one I saw post anything about curling the tube prior to insertion by wrapping it around your hand (kinda like a boxer tapes up his hands), it helps the tube to follow the natural anatomical curves. I also agree about warming the tube, not making it colder. It seems like a stiff tube would be high risk of causing trauma, and more uncomfortable for the patient (like brain freeze from a slurpee lol), and be kind of a shock to the stomach, just like you wouldn't flush an NG or PEG w/cold water. I also have the patient tilt chin to chest, and if its not contraindicated small sips of water can help them to swallow. and always remember to make sure there isn't a chance of basilar skull fracture! Hope that helped
If the patient is awake and able to follow directions, make sure to tell them to SWALLOW. That makes it a lot easier if they cooperate with getting it down.
Specializes in Emergency/Trauma/Critical Care Nursing.
If the patient is awake and able to follow directions, make sure to tell them to SWALLOW. That makes it a lot easier if they cooperate with getting it down.
If they're not, then just shove it down!
lol if they're not awake or following commands i'd go for an OG tube b/c i'm guessing they are intubated or headed that way lol
Specializes in Emergency Medicine, Sexual Assault.
I have then swallow some viscous lido, the nose usually isn't the issue but rather the rampant gagging that occurs as you get farther. Also, the chin to chest thing has always made it more difficult than easy for some reason. I've found it a little better to have them look up a tad, but try them both and see which works. Last, definitely wrap it around some fingers to curl it first.
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...
I learned this trick from an ER doctor when all else failed. It really seemed to help.
Plus asking the doctor for a small dose of Ativan can really help things go easier. I mean Ativan for the patient, not the nurse! Although that might help too
It's such a miserable procedure. All the above tips are good. I think half the trauma from NG insertion is lack of control for the patient, and they panic. I know that the worst parts are when the tube makes that turn from going up the nose to down the throat, and when it triggers the gag reflex, so I warn them of that. I know the urge to just grab the tube and pull it back out is greatest at those points so I warn them, and tell them to hold up their hand if they want me to stop. I'll stop right there until they give me the go-ahead to proceed. Then they feel like they're in control of the whole procedure, and we don't have to start from scratch. I try to make them understand that I need their help to get the tube in the right spot, and have had a lot less trauma with NG insertions when the patient knows they are part of the procedure, instead of having it done to them.
LilgirlRN, ADN, RN
769 Posts
This is what I do.... barring any med allergies.. I take qtips and dip them in viscous lidocaine and put them in the nose for about 5 mins. I spray the back of the throat with cetacaine. I lubricate the tube with viscous lidocaine. I look up both nares, ask if the pt has ever had a broken nose or deviated septum. I pick the biggest one and SLOWLY insert the tube, oh and I curve the end of the tube so that it goes into the naso-pharynx more easily. Go in until the measured spot and listen with the stethescope as I inject air then tape it into place if it's in the right spot. Hope this helps.