NG tube help

[tsm007]

Well I feel like a big bozo, but I messed up on the skills lab on NG tubes because I misidentified the lumens. In lab when we practiced, the end you aspirate from had a cap on it and you took it off to aspirate. So when I went to take the test there was a cap on the air vent and not on the end you aspirate from so I messed it up. I realized the cap for the lumen you aspirate from was in the bag after I was done. I should have realized when I met such resistance removing the cap that I had the wrong end, but all I remembered was taking a cap off, drawing back aspirate to check placement, and replacing the cap when I was done. I didn't remember there being any type of cap on the air vent. Obviously, I need to learn how to identify the two lumens on NG tubes. I already feel like a complete idiot. How exactly do you tell which lumen is the air vent and which is for aspirating from? I'm obviously missing the obvious.

[ckh23, BSN, RN]

The one's we use in the hospital, the air vent is blue and the lumen is much smaller if you pull off the cap.

[KelRN215, BSN, RN]

I assume that you are talking about salem sumps and not feeding NG tubes.

The air vent is usually the distal port in all versions that I have seen, like this one:

Salem Sump Tubes at Emergency Medical Products

You may or may not need to keep the cap in that picture on the other lumen depending on whether the tube is going to low wall suction (keep it on) or gravity (take it off depending on the kind of bag you're using... I have always just used a foley bag and shoved it into the end of the tube).

[tsm007]

Thank you both. That helps.

[KatePasa]

The air vent is called the blue pigtail. Think of it that way and you'll never get them mixed up!

The blue end of the cap goes in the pigtail. The white end can go in the NG tube if you need to disconnect it from wall suction for ambulation or transport.

[futurenrse823]

Hey Supermama,

I tried sending a message to you but I can PM quite yet. I was wondering how things are going at Wishard?? There's a cohort starting there in September, which I'm applying for!! I was also wondering if you could possibly post your schedule for this term? I just wanted a tentative idea of what the scheduling is like. And as for the NG I messed up this before too, my instructor was very dramatic and acted as if there were gastric juices and since I didnt clamp the tubing she acted like it was spraying everywhere, funny, but I'll never forget the difference in the tubes ans I'll always remember to check which is which. You'll be fine, we all have to learn someone and everyone forgets every now and then.

[nurseprnRN, BSN, RN]

before salem sump tubes were invented, all we had were single-lumen tubes to suck out stomach contents. what's the problem there, you say? well, if suction has removed all liquid stomach contents and it keeps sucking, what you get are little punch biopsies of the stomach mucosa, and this is not a good thing. so, some clever person (perhaps a salem witch) figured out that if there were a way for the suction to have something else to suck on, to break the vacuum in the stomach, like air (and any other fluid that happened to accumulate too, of course), then this would protect the stomach from having vicious little hickies from suction at the eyelets down below and bleeding and such.

the air vent on the salem sump is that solution. air should always be going down the blue lumen. how do you know if that's happening? well, you can put your ear near it and hear it, or put your thumb over the end of it briefly and feel suction there, but the best way to see is that there should always, always, always be air bubbles coming up the main lumen to your suction cannister. now you know something important: if it isn't, there's hickifying going on down there, and that's a bad thing.

the air vent lumen should always be patent (open) all the way down. if it isn't you can do a couple of things (after you have determined that some fool has not turned off your suction outlet). one is to untape the tube and pull it back an inch or so, and then put it back. you can also push some air (not fluid) down the blue lumen. yes, you may have to do this all dang day long, but you will often be rewarded by a gush of gastric goo, which is what you wanted anyway.

what's going on if there is no air coming up the main lumen and there's goo coming out of the air vent? well, (assuming your suction is still turned on and plugged in properly) your main lumen is probably occluded and goo has nowhere else to go but up the air vent, and you should probably think about replacing the whole tube. but before you do that, if it's not otherwise contraindicated, shoot some ns down both lumens, and follow that with air down the air vent lumen. see if that doesn't get things moving properly. if not, do the wiggling thing as above. if that doesn't work, get the ok to replace it (or have the physician or np come and replace it).

some salem sumps come with little plugs in the blue lumen. they're supposed to allow air entry and prevent backflow but they don't always really do a great job of it. if you can still verify air entry past that plug and bubbles are going up the main lumen, it's fine. but if it's gotten grubby and acts like an actual plug, get rid of it, or what you have is now a gastric mucosa-grabbing single-lumen tube.

[tsm007]

GrnTea - That was very helpful. I do a lot better remembering things when I know the *why* behind it. I am sure if anything I will not screw this skill up again. I keep trying to remind myself that some of the best learning lessons are from making mistakes.