NG Tube Yields 2000 ml Immediately

hypocaffeinemia, BSN, RN · Apr 17, 2008

I'm a second-semester student. We actually had a lecture on the importance of the NG tube as a treatment for SBO from one of the local general surgeons. I can't believe she waited two days which such obvious and worsening symptoms before anyone elected to place the NG. Good on you.

:up:

Silverdragon102, BSN · Apr 17, 2008

I had something similar when I first qualified in 1988 and it was the day staff that was reluctant to do anything. Patient admitted medical and everyone said she was a hypochondriac and there was nothing wrong with her. Initially gave her phosphate enema as prescribed by doctor but eventually had to pass NG tube and I must have received well over 3 litres and was worried may go into shock. Doctor wouldn't believe me until I said well come and check it out. She settled for the night but was in surgery next day and transferred to care of surgeons.

nrsang97, BSN, RN · Apr 17, 2008

OMG I had the same thing happen. Pt received as transfer from the ICU at near end of my shift. I thought "this guy dosen't look good". His belly made him look pregnant. I passed NGT and got half a wash basin full or about 2L. Plus what we got out by suction. Pt was there the next day, and Dr had nurse pull NGT. I again come on shift and pt again distended belly. Hard time inserting NGT call house MD again tons of drainage. They were trying meds to stimulate peristaltis. Not working. NO BM. Pt still distended. Sent back to ICU at one point. Sent back to our floor. Same room. I had a day off and called the nurse on pm shift and told her to watch him. He ended up coding that night and dying, why necrotic bowel and septic. WHY WHY WHY did that nurse keep listening to the doc and pull the NGT??? I kept telling them something was wrong and NO ONE except the house MD and MD on call would listen to me.

I am sorry that your pt had to suffer. I am glad you are the patient advocate that you are. Good for you.

MikeyJ, RN · Apr 17, 2008

I would report the nurse that preceded your shift because it was obviously an MD order that was not followed through.

allnurses Guide · Apr 17, 2008

I bet your patient felt loads better without 2 litres in her belly.

As for the previous shift, I know here in the UK I occasionally struggle to get ward nurses placing NG tubes as it is not something that is covered in thier training now so when they qualfiy them may never have put one in. When I trained it was something a 2nd year student would have been expected to do. In an patient with a distended abdomen and vomiting it would have been something that we would do without a doctors order but then passing an NG is not something that we need to get a doctors order for in the UK, it can and often is a nursing decision.

I spend lots of time supervising and teaching rather than putting them in myself. Could it have been the previous shift wasnt confident to do it, obviously they should have sought help but just a thought.

Silverdragon102, BSN · Apr 17, 2008

I bet your patient felt loads better without 2 litres in her belly.
As for the previous shift, I know here in the UK I occasionally struggle to get ward nurses placing NG tubes as it is not something that is covered in thier training now so when they qualfiy them may never have put one in. When I trained it was something a 2nd year student would have been expected to do. In an patient with a distended abdomen and vomiting it would have been something that we would do without a doctors order but then passing an NG is not something that we need to get a doctors order for in the UK, it can and often is a nursing decision.
I spend lots of time supervising and teaching rather than putting them in myself. Could it have been the previous shift wasnt confident to do it, obviously they should have sought help but just a thought.

Was part of my training but that was back in 1986

NurseCherlove · Apr 17, 2008

I hate to say it but I would probably from there on out be somewhat judgemental of that last nurse - you know, going over EVERYTHING with a fine-tooth comb after getting report from her b/c you know things have not gotten done.

Nurses like that are the reason I love the concept of walking report - you have the chance to at least get a cursory glance of the patient and get to hold that nurse responsible for at least the immediately obvious things that need to be taken care of (empty IV bags, pain needs, etc.).

One thing I do wonder about is, why did the MD not just go ahead and order for the NGT to be placed (non-elective) when he saw her on his rounds. A patient does not just suddenly develop massive abdominal distension. Did he not do a patient assessment? Sadly, I have seen docs come in and write a progress note without ever even laying a hand on their patient. Heck, I've even seen one write a note and not even go in to talk with the patient!

Nurses like that give the term "nursing judgement" a bad rap. I guess that MD had more confidence than he should have in those nurses.

nightmare, RN · Apr 17, 2008

Was part of my training but that was back in 1986

Yes me too! As SD said ,part of our training,and we were better at it than the junior doctors!

leslie :-D · Apr 17, 2008

gawd, that poor lady.

it's a no-brainer that a pt w/sbo & distended abd, needs relief...

and immediately.

shame on the dr. for not mandating it:

and those nurses whose judgment, sucked.

leslie

SDS_RN, RN · Apr 17, 2008

Not quite the same circumstance but similar situation. I had a pt that had hip surg and pretty soon he's distended nauseated then started w/ the emesis. Called the doc x3 that noc finally on call #3 I had to request the NG as soon as I got that puppy in there bam 1L out immediatly. The guy ended up going to the unit that day and died r/t free air in the abd because this pompus doc refused to return 7 phone calls from the ICU staff. Unsure of how the entire situation went down but it wasn't good.

This man was in his 80's but come on something could have been done for this man so he did not have to suffer that way. He got a good chewing from the surgeon which he deserved but too little too late.

HopeItWorksDNP · Apr 17, 2008

The RN that I work with in the ER actually runs and hides if she sees an order for NGT to be dropped. She will stay hidden until I have it done. What's the big deal? We do a lot worse things without as much benefit in return....