NG Tube Placement in Lab

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Hi guys! I just went to our welcoming reception this morning and I found out that we are going to practice IV, blood draw, injections and NG tube with our partners. I'm starting the program next week and I'm not looking forward to the NG tube part. Can anyone tell me how that is done and do you have any tips on how to do it correctly. I know that we will be trained first before doing it on ourselves but I just want to get a little insight from those of you who have done this before. I'm getting pretty nervous about this one:eek: . I need some advice please. Thanks a lot!

Specializes in Nurse Leader specializing in Labor & Delivery.

We do not practice any invasive procedures on other people, and frankly, I would have some serious issues about that.

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Specializes in Neurology, Neurosurgerical & Trauma ICU.

You all can't see it, but my chin is laying on the floor right now!!! :eek:

I have serious problems with placing an NG tube in someone who doesn't need it!!!! What is this school thinking????

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wow...I would have to decline on the ng tube...even if I needed one I'b be scared you-know-what-less! That is way too invasive, painful, and potentially dangerous! Yikes!

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I am doing an externship in the MICU and have done about 5 NG placements....they can be tricky when a person has an Endotracheal tube in....the tube can come out through the mouth.........you can't have them swallow water...

gosh...but have you practice putting NG tubes in on students.....no way jose....just the thought makes me cringe....

those can be traumatic....and you can't sedate them (the students)...

everyones anatomy is different....

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Specializes in ER, PACU.

Make sure you use a 14 guage salem-sump tube and that your partner has a full stomach before you insert it, while the end of the tube is pointed directly at your instructor! :devil:

Seriously, I dont see how they could do this at your school. When I insert NG tubes a work, I use viscous lidocaine on the tube, as well as have the patient drink some of it before insertion unless its an emergency or they are unconsious. You should have the patient sit up, bend the head foward, and then insert the tube. Once they start to gag, tell them to drink the water you provided them and this should help the tube go down. Make sure to check for placement before administering anything down that tube.

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Make sure you use a 14 guage salem-sump tube and that your partner has a full stomach before you insert it, while the end of the tube is pointed directly at your instructor! :devil:

Make sure to check for placement before administering anything down that tube.

That's a good one!:rotfl: I'll make sure to do that on my turn. The only problem is I don't know what a 14 gauge tube is:chuckle .

But seriously, how do you check for placement. That's one of my concerns since I found out about this. I know we'll be taught that but do you have any tips on that. I found an article in the web about wrong placement and it ended up in the lungs and that scared me. That was one of the reasons why I'm seeking advice here.

Anyway, thanks a lot guys for your input.

gem

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you check placement by putting your stethescope over the epigastric region and using a 60 ml syringe blow air (about 10-20ml) through the NG tube and listen for a whoosh....keofeed tubes have a wire and placement must be verified with an xray.......KUB (kidneys ureters bladder).....although you can listen for the woosh....BUT IT MUST BE VERIFIED WITH AN XRAY...the keofeed....

LUNGS....watch and see if the patient is coughing alot and if the o2 sats are dropping.....

2 nights ago a patients NG tube got coiled up in the esophagus...not good....

you measure for length from tip of the nose to ear lobe to xyphiod process and then an inch or 2 for measure.....

all patients are different.....some are easy to get in and others aren't....some will fight you others will not....

NG tubes can also be placed orally....OG tubes.....

another thing....when you lay the patient flat the tube feeding the patient might be on needs to be put on hold so they don't aspirate...

my IV track record is better than NG.....

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Specializes in ER, PACU.
That's a good one!:rotfl: I'll make sure to do that on my turn. The only problem is I don't know what a 14 gauge tube is:chuckle .

But seriously, how do you check for placement. That's one of my concerns since I found out about this. I know we'll be taught that but do you have any tips on that. I found an article in the web about wrong placement and it ended up in the lungs and that scared me. That was one of the reasons why I'm seeking advice here.

Anyway, thanks a lot guys for your input.

gem

I just realized, I should have said 14 FRENCH NOT GAUGE. First thing I will tell you is that, make sure the patient is sitting up with head tilted foward. This positioning will help you avoid putting the tube in the trachea. Secondly, your patient will cough up a storm and gag even if you are not in the wrong place, so this is not necessarily a reliable way to tell if you are in, although one of the two patients that I saw that was tubed in the trachea was coughing so hard that we figured was probably not in place and pulled it out. The other patient we had that was tubed in the trachea was also intubated and sedated, so there was no gag reflex there. Usually we put NG tubes in patients in our ER because they have some kind of intenstinal obstruction or bleed. Usually once the tube is in the stomach, whatever fluid has been sitting there comes shooting out the other end of the tube, but if they have an empty stomach you may not see anything come out until you hook it to suction. I usually have a hard time inserting the tubes, they are so thick and made of hard plastic, so I almost always get a pretty good resistance, and I dont want to force it too much, so I tell the doctor to do it. Never force a tube that you cant get in fairly easily. What we do to check placement, and what you will learn in school, is to get a big catheter-tip 60 cc syringe and push about 30 cc of air through your end of the tube while you are listening with your stethoscope over the stomach. We also have the patient say his name after the tube is in, because if it is in the lungs they usually wont be able to speak. You can also withdraw from the tube and test what liquid you get with litmus paper to determine pH. If it is acidic, and greenish in color (in school they say its "grassy green", but if your patient is obstructed or has bleeding, it can be a variety of colors), it is probably stomach content. Wait until you insert your first NG tube into a patient that has a bowel obstruction and you get back 2 liters of feces!! That has to be the grossest thing ever! Phlegm and other liquid from the lung is basic. Just remember to check placement EVERY TIME you plan to use the tube for meds, feedings, whatever. Patients tend to play with the tube, and it can be easily dislodged, and you dont want to be giving them a bolus of water/feeding/whatever, into thier lungs. Just follow what your instructor or the book says, and you will do fine.

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another thing....wrap and piece of tape around the tube and safety pin it to the patients gown....so it isn't flopping everywhere....

patients WILL pull it out themselves....

I agree...don't force anything.....

To take them out....all you do it remove the safety pin and pull....I usually put a chucks pad on the patients chest and give them a tissue.....

what I learned in nursing school...if the tube is too stiff, put it in some warm water, if too flimsy, put in cold water...

I had NO NG tube putting in experience in the year I was in nursing school....everything came from my externship....

DO AN EXTERNSHIP.....

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PSU and imagin, you guys are awesome! Thanks for your great advices. I'm glad that I found this forum because all of you are so helpful. My class hasn't even started but I'm already learning a lot. Now I know what to ask for when our instructor shows us how to do this. Maybe we should practice on him first:chuckle. By the way, do you think that I can say no to this if i'm not comfortable with it. I think I can handle doing it to my partner but not to me. I guess I have to wait and see. All I know from a previous classmate is that it's mandatory to pass the class.

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I cannot believe that this is mandatory....WHERE DO YOU GO TO SCHOOL.....

ok....this happened to me when I was putting in an ng tube....

I tried one side and it wasn't going in well....so I tried the next.....I was feeling for a way down and I wasn't finding anything...I pulled the tube out and there was this long streak of blood.....it was oozy for a while...they ended up having to pack her nose....

things happen....i didn't force....but this happened....and things will happen....as I said...EVERYONE'S ANATOMY IS DIFFERENT....PATIENTS WILL REACT DIFFERENTLY....

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In the real world it's your tushy on the line....if you don't feel comfortable doing something don't do it....

I did clinical at hershey medical and one of the nurses said that she had been out of nursing school for a few years and still hadn't done and NG tube....it isn't like you are going to be a master practicing on your fellow student....

I have problems with this instructor of yours....

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