NG Tube Anxiety

[alex-333]

I'm in my second year of my 4 year BScN in Ontario and I'm incredibly emetophobic (I know, I'm in nursing school and I can't handle being around vomiting, I understand the irony) Anyways, I'm becoming a bit better being around people who are vomiting but the idea of inserting an NG tube terrifies me. It's a skill that we will have to learn this term but I'm desperately hoping it will be a skill that I don't have a chance to practice in clinical to be honest. I feel very uncomfortable basically forcing someone to vomit right in front of me. If I'm planning on being an obstetrics nurse, do you think my lack of skill in NG tubes will affect my practice? I'm hoping someone will tell me that I may never have to do one in my life as a nurse. But I'm also prepared for the reality that I might just have to suck it up and do it. My passion is in women's health. Teaching new mothers, caring for moms post-partum. I really think that's where my future lies. Med-Surg terrifies me and I dread going to clinical every week. Only 11 more weeks, I just have to keep reminding myself! I think I just need some helpful words from experienced nurses!! Thanks :)

[rncat2000]

I understand your nervousness about this skill, but it really isn't as bad as you think it will be. :) I have been a peds nurse on a postop surgical floor for almost 10 years now, and I can say that I have only had 1 patient ever vomit with a ng tube placement. All of them will gag but for the one patient they never threw up. It is a skill that every nurse needs to learn but not every nurse will use it in the course of their career.

[smoup]

I haven't had an NG placed, but I have had a manometer placed down my nose into my stomach and it's just not that bad. Granted, I wasn't the one doing it but from the patient's perspective, it was less of a big deal than I thought it would be.

[Stephalump]

If it makes you feel better, all two of my NG tube placements thus far have been vomit-free.

I was very unenthusiastic about that particular skill, but in my mind, all the more reason to do it ASAP. The longer you fear and avoid the monster, the bigger it gets, so rip it off like band-aid. If you aren't naturally tenacious, fake it til you make it ;-)

[nurseprnRN, BSN, RN]

Wait-- did you say "forcing someone to vomit"? I don't think so. I've sunk approximately one bazillion Salem sumps and I can't think of much vomiting going on. I mean, you can slide that baby down slick as a wink, and you avoid the vomiting thing. That's sort of the point :) .

Secrets to easier NG tube placement:

1) Explain it all to your patient ahead. Say, "I'm going to slide this clear tube into our nose with a lot of slippery lubrication so it won't be scratchy. It will come down the back of your throat, and when it gets there I'm going to ask you to swallow, swallow, swallow to help it go right down into your stomach as I advance it. Before I start I'll hold it up like this to check the length (you know, or will know, how to do that) and when it's down I'll check to see it's where I want it. Any time you want me to slow down or stop for a sec, you let me know, OK? Good, here we go then."

2) And you use an enormous slug of KY, which you have thoughtfully warmed up before you start, either in the little foil packets in warm water or in your gloved hand, and you have also warmed the tube in warm water so it's softer and more pliable,

3) and you have a cup of water and a straw for the patient to sip on to help with the swallow. I know he's probably NPO but if he's conscious and has a safe airway, those few sips'll be coming right back up the tube in a New York minute, so no harm done.

4) Swab a little benzoin on his nose and wait for it to be properly tacky, then attach the tape or other securing device. Aspirate the tube for pH check to be sure it is where you think it is (those few sips help with that too). If your place requires an x-ray or other confirmation, do that. Hook up to suction and be sure the air vent on the sump is working -- you should see air coming UP the tube if it is.

If you get the chance to observe in the OR, ask the anesthesiologist if he can teach you how to do this on an unconscious person. That's a piece of cake. You get to skip the explanation and go directly to checking length and inserting with lotsa lube. You can even put your two first fingers over the tongue into the pharynx and feel it glide between/over the back of them right on down so it goes posterior (esophagus) instead of anterior (trachea).

[alex-333]

That's actually great advice! I think I just need to get over it. The sooner I'm not worried about it, the better I'll be able to handle it when the situation arises!!

[KelRN215, BSN, RN]

Placing an NG tube is not "forcing someone to vomit". I've never had anyone vomit during an NG placement and the patients I'm typically placing them on are children who are flailing about and screaming.

[DalekRN]

I'm a postpartum nurse and we place orogastric tubes to do gavage feedings for babies who are breathing too fast to eat normally. It goes fine and you get better with practice. There's not much you can do with an infant that a pacifier and some sugar water can't somewhat soothe.