NG tube irrigation

[rck213]

Most of the nurses on our unit have 20+ years experience and have always used NS for NG tube irrigation and pulled back what we instilled.

A newer nurse has told us we are all wrong in using NS, sterile water should be used as saline will alter electrolyte balance.

We have no comeback except that NS is what we were taught to use. We checked for a hospital policy and of course there is none and we have no resource clinician.

What is to be used and why?

[jadednurse]

Have always used tap water too.

[Kayde]

Angus, great explanation. Weve always used normal saline and never asked why.

[mistersleepy]

Memo to students:

If you ever try to unclog an ng with coke, make sure that your instructor isn't standing on the recieving end of the toomey syringe!

(Either time) LOL

Robert

[Brownms46]

I'm sorry I disagree with you Angus, on the statement that most pts. have NGTs placed d/t dysphagia, and not abd problems. In acute care I have seen NGTs used mostly for post op/pre-op to reduce risk of aspiration, for abd distention/ abd trauma/obst/to monitor GI Blds...etc.

A pt.'s dx/ age , and or MD orders, may determine whether or not you use water or NS. Pts with free water restriction should be irrigated/flushed with NS instead of water, such as in pts with hyponatremia. Some MDs may order .45 NS for irrigation of NGT's. :)

I do however agree about the warm tap water, when not counterindicated.

[nowplayingEDRN]

I think it all depends on what the doc wants. Usually we use tap water....post op RGBs we use sterile water (when ordered by the doc of course) just in case of leakage......as for unclogging the tube.....I was taught to use cranberry juice or gingerale and both worked marvelously well........never gave more than a syringe full of it and it never seemed to affect the caloric count or glucose of my patients (I was taught those 2 tricks by a diploma school nurse, who still practices today and is a very dear friend of mine.)

[elyses]

What if the nurse on the shift before you pulled out emesis from the blue tube (I thought it was an air tube) 240cc emesis.

See the suction machine wasnt working (per the nurse on day shift), the patient has lots of emesis-there wasnt another suction machine or ng tube to use-it was Saturday....so, the day nurse decided to suction out through the blue tube 240cc emesis-and then her intent was to send the pt to the hospital/or get another suction m machine on Monday.

Now, is what she did going to hurt the tube or the pt?

Should I now, tonight, Tuesday, clear out the blue tube-I guess I could leave the suction on, irrigate with 30-60cc warm water in the blue tube-

(See, the Nurse Sunday was concerned and sent the pt to the hospital on Sunday morning to check Tube placement? it was correct and they took the NG tube out to clear it out and put it back in. And yes, that was a $700 charge by EMS!! We are a long term care facility) I assume the tube was clogged....now there is an order to irrigate w 20cc water. There wasnt an order before-i didnt know we needed an order to irrigate an NG tube?

[netglow, ASN, RN]

Yes you should have orders on what the heck to do with that NG. You should have orders on suction (continuous? intermittent?) what pressure, and how long for, irrigation too. You should have orders. You need to look up your specific tube and understand what it's for. You should be documenting what goes in and comes out. You should be assessing your patient closely and fully on all fronts. Using an NG incorrectly can lead to metabolic issues amongst other things. Get on it.

[RNCEN]

We were just taught to use NS for irrigation.

[nursegirl776]

Isn't NS isotonic so it shouldn't disturb F&E balance unless something else is going on? Tap and sterile water, while fine for a healthy person, could cause F&E shift in someone already facing some challenges in that area. Or am I totally wrong? Just a 2nd semester student so just when I think I'm right...I'm not:nailbiting:

[jdraper]

I am a current nursing student and we are taught (book too) to use NS for NG tube irrigation.

[Christy1019, ASN, RN]

I went to school in the past 5 years. Tap water is used. Additionally every facility that I am familar with uses tap water.

The stomach is never a steril enviorment. Yea an acid imbalance could cause problems. Think about this. If you do not have an NG and you drink your fluids and you have a lack of HCL you still do not drink a steril solution nor do you drink N/S.

An NG tube only by passes the fluid comming in contact with the tissues of the mouth and throat. It does not alter anything about the stomach. NGs are used most often when there is a swallow problem and not because there is a stomach problem.

Most of the time I am sucessful unclogging tubes with warm H2O. Bicarb is useful if prevacid is blocking the tube. It is the Acid in coke an fruit juice that supposedly unblocks the tube. But like I said warm H2o has been my best friend here.

Some one said that 1-2 oz of NS wont upset lyte balance that bieng said, 1-2 oz of tap water in the stomach where tap water is normally put will do no harm. So why use $$$ N/s or steril water?

As far as diarrhea goes we do not treat diarrhea with 1-2 oz N/s nor steril H2o so why would you just because there is an NG. We don't even when they are on a proton pump inhibitor

I totally disagree with your statement regarding NG tubes primarily being used for dysphagia and not gastric issues. If pt has chronic dysphagia or refusing to eat, etc and can't swallow w/out risk for aspiration or uncooperative, they probably won't be able to swallow for placement of the NG tube either which will increase the risk of accidentally placing it in the bronchus or lungs, so these pts typically will get PEG tubes placed instead. Also, in an acute setting, NG tubes are mainly used for gastric issues I.e. small bowel obstruction (gastric decompression), and GI bleeds (for NG lavage which helps differentiate upper and lower GI bleeds).

The minimal amount of fluid being infused when irrigating a NG tube is not generally going to have any effect on the lytes and if being used for lavage or to check if tube is patent, the fluid will typically be suctioned back out or drawn out by the toomey syringe. Unless there are extenuating circumstances, any of the three fluids can be used but I personally use sterile water b/c it is already room temp, and easier to pour from its bottle.

[RoyalPrince]

I use sterile water.. only because its available.. why not?