Nervous Nurse's Guide to NG Placement

[JeneraterRN]

The following is intended as a quirky look at policies and procedures. I've been having to write quite a few, and this popped into my head while remembering my first day in ICU with a critical patient. Enjoy!

Procedure: NG Placement for Intubated Patients

Bleeding Heart Memorial Hospital dedicates the highest quality care to each patient admitted to the ICU. NG placement is indicated for vented, unresponsive patients, those with intractable N/V, those requiring general gastric decompression, and those that are generally irritating and miserable individuals bent on spreading their malodious attitude.

Preparation and setup:

1. Gather equipment

A. Obtain appropriate size Salem Sump tube, piston syringe, cup of water, straw, and emesis basin. Remember, the key to success in all endeavors is lubrication. Unless, of course, this NG is indicated for the aforementioned irritating person. Then, it is strictly optional. Also required is a method of securing the catheter once placed. Since mastisol and secures are too expensive, tape will have to do.

B. Open packaging, set up equipment keeping in mind for ease of placement.

2. Measurement

A. Run the tube from the xyphoid process, turn it around the ear, and mark the spot next to the nose on the catheter.

B. Explain to the patient what is occurring in a calm, collected voice. They may have noticed at this point how frequently you have dropped equipment. Tell them this is standard for this procedure.

3. Placement

A. Examine the nares, making note of any obstruction or septal deviation.

B. Give the patient the water to drink, if conscious, and lubricate the tube.

C. Have the patient drink water while advancing the tube in the chosen nare.

D. Duck because you've forgotten to give them the emesis basin, and they are now projectile vomiting.

E. Change your clothes because you've forgotten to wear a gown, and also the linens, patient gown, and curtains.

F. Place the emesis basin in front of the patient.

G. Ignore the doctors joking about "Ativan air freshener." The patient is nervous, but who wouldn't be? NG tubes suck.

H. Reassure the patient that all of the previous steps occur regularly and just need to be dealt with in an according manner.

I. Get up off the floor after slipping on vomit, change your clothes again.

J. Advance the tube in the chosen nare again while patient is drinking. Fortunately no emesis will occur now.

K. Use the piston syringe, place air in the line while auscultating over the stomach. If you cannot hear an air bubble over the coughing and swearing, go back to step F.

L. If an air bubble is auscultated, secure the tube to the nose and gown.

M. Explain to the patient that despite the overwhelming urge to rip out the tube and wrap it around the nurse's neck, it must remain in place to maximize therapeutic effect.

I hope this cheer someone up today. Sorry about the formatting, my computer is misbehaving.

[Esme12, ASN, BSN, RN]

Loved it....although I very sledom gave water to drink. Working In the Emergency Dept, I got tired of having it spit in my face....

[applewhitern, BSN, RN]

This all sounds pretty accurate to me! Might I add that for the most annoying patients, you should choose the largest size salem-sump you have in stock.....thanks for the laugh.

[Biffbradford]

CXR to verify that you've got it coiled up in the back of the throat.

I had one placed in me before surgery once. Like having a 3 ft long #2 pencil shoved up your nose. Eeeeew.

[Esme12, ASN, BSN, RN]

This all sounds pretty accurate to me! Might I add that for the most annoying patients, you should choose the largest size salem-sump you have in stock.....thanks for the laugh.

Nah......I like an "EWOL"better.(code blue easy lav 32 fr)...I call it punitive medicine..

[OCNRN63, RN]

Thanks, Jen! It definitely made my day.

[Sun*shine]

The final step after all that drama is seeing them return from xray with the tube now coiled around their hand.

[whichone'spink, BSN, RN]

You should start your own AN blog. Too funny.

[JeneraterRN]

You should start your own AN blog. Too funny.

Thanks! I was thinking about writing some more "procedures." Glad you all liked it! I should have spent more time proofreading and adding, but I had to go work in my garden.

[jujuseah, RN]

In Singapore, we are not allow to auscultate for "air injection" but to check for gastric content, PH and CXR. but of course, sometimes i would still do that. i'd feed the pt with plenty of water and voila when you withdraw, you should be able to see fluids - get a double confirmation with another RN or repeat an CXR if unsure.