NG insertion fail..anyone else?

[zacarias, ASN, RN]

Hello!

OK so I'm a seasoned nurse working in med/surg in a smaller hospital. I usually do PCU/stepdown or tele but am doing med/surg during my current assignment.

Anyway, last night I had a new admit that needed an NG tube preop and I've always thought NG tubes insertion was an "easy" nursing task. I've done some in my career and there's been no problems. My patient last night was a problem for some reason. The first attempt she was flailing and not taking sips/swallowing like I asked her to. The second time it met resistance and could not advance it. I don't understand it. Later the son told me that she had a traumatic NG tube insertion when she was 6 years old (she's almost 80 now) and she's still traumatized by it.

I hate when my interventions don't go as I plan 'cause I feel like I'm too blame. I asked her about any nose issues before (of course later she said she stuck a whole apricot up her nose when she was a kid), I measured, I lubed the NG but it just wouldn't go. The surgeon was fine that she didn't have the NG but I'm going around in my head thinking about what I didn't do right or if I did what I could.

Thanks all for reading.

Z

[LovingLife123]

Could it have been an anatomical issue? Especially if she had a traumatic insertion in the past?

[brownbook]

You be crazy man! Yeah, maybe if you inserted NG tubes every day you would feel badly. Any skill you do "some in your career" you are not going to be successful at every time!

I have had problems. I have seen gastroenterologist, anesthesiologist, and surgeons have problems passing NG tubes.

Just curious, do you get IV's in on the first stick every time? Even nurses who work on the line team who say they always get their first stick, never fail, never have to call a co-worker, etc., are lying. It is the same idea.

[NurseSpeedy, ADN, LPN, RN]

I've seen many patients that are not "easy" NGT inserts, especially recently. Have worked with GI doctors to try to maneuver the tube in and eventually they get it, but I wouldn't feel comfortable doing all the maneuvers that they did to eventually get the darn thing to pass.

Of course this is always the patient that finds their way out of their restraints with just enough time to yank the damn thing out during the one moment I take to go check on the rest of my group!

[Cowboyardee]

A few rules of thumb:

It is something like 15-20 cm for most adult patients for the NG tube to pass through the nasal passages and into the pharynx. If you meet much resistance before this point, you're just not going to pass a standard NG tube in that nare, regardless of your technique - the patient's anatomy doesn't allow for it. Consider a dob hoff tube if you don't need suction.

It is about 45 cm to the average adult's carina. If you meet resistance at this point, it very often means you are in the patient's lungs. Pull back to 10 cm or so, tilt the chin down, encourage the patient to swallow and try again.

I'd say not to worry about being unable to pass an NG tube, since some people just have nasal passages that allow for it. But it is a bit uncommon that you'd be able to pass the nasal passage the first time and not be able to on the second attempt (which is how your post sounds).

[akulahawkRN, ADN, RN, EMT-P]

I have had reluctant patients actually thank me for inserting their NG tube... but my technique is NOT different from the the standard way of inserting the NGT. The thing I do is choose the size to fit the anatomy. Most of the time the patients get a standard 16F but those with anatomical issues often end up with a 12F and that usually goes down without too much trouble because the pain/discomfort in the nasal cavity/nasopharynx is decreased from what they're used to.

Remember that inserting an NGT is not comfortable. Tuck chin to chest with a sip & exaggerated swallow usually does the trick.

[Wlaurie, RN]

Don't know if it would have helped in this situation but I had to put one in a 90 something person and it kept flipping around. She wasn't able to help. The icu nurse taught me to soak it in ice water to stiffen it up a little and then it went right in.

[mnera09]

I had an old charge nurse that told me to do the opposite. She soaked the tip in hot water to soften the tip into a curled end. Then let it cool in the new shape before inserting it. Worked like a charm.