NG tubes

hunydew2262 · Dec 1, 2008

We just certified in this as well. One of my instructors said you can give the client a small amount of water to sip while inserting the tube. The client swallows the water and the tube and the water will be suctioned right out. I'm sure there are many situations where this would be contraindicated, but that was one trick we were given.

My understanding is the tricky part is getting the tube past the soft palate at the back of the throat. You think everything is going well and the tube comes out their mouth! I had to advance an NG tube that had partially come out and it hurt the guy so much he cried. It was as traumatic for me as it was for him. I left the room and cried, too.

Good luck!

Huny

Aneroo, LPN · Dec 1, 2008

One big tip for kids- if they take a paci, give it to them. My first NGT was on a baby. I was scared to death, and my instructor was in there with me- I dropped it first time, and when I hit resistance, I said "Let's give him the paci". He started sucking, and this was enough to help him swallow the tube.

On adults, I also would usually let them drink some water if time allowed and they were somewhat stable and protecting their airway.

If it was someone with an ETT, I waited until the tube was in and then did an OG tube. I could use a bigger size, and it was easy to insert (they're asleep and they're already a tube in trachea).

If possible, I'd try to get an order to use cetacaine with it to numb the back of their throat to lessen the discomfort.

Mommy_of_3_in_AL..RN · Dec 1, 2008

The only one i have tried to place, i was very unsuccessful. The guy was a really big and strong guy, and i am maybe 100 pounds soaking wet. He was extremely agitated..they had just put in a femoral cath and started him on CRRT, and he was very sick and confused. Nerologically, he was unaware of what was going on..all he knew was that we were trying to shove things down his throat, and he didnt like it. Needless to say, i ended up straddling him and the bed..i was kind of hanging there on him..he kept gagging and spitting and vomiting on us..well me mostly. We tried the water/ice trick (he refused to swallow), we tried to numb his throat, everything. Finally, i remembered that he liked strawberry ice cream...alot. The doc said we coud try to trick him by giving him a bite, them quickly getting the tube in while he swallowed. It worked, although that finally got done on night shift so i wasnt there. I was next to last semester in school..i felt like i failed until i realized that everyone on the floor was unable to get it. I graduate in 2 weeks, and still havent had another oportunity. The thought of it makes me shudder....

Aneroo, LPN · Dec 1, 2008

The only one i have tried to place, i was very unsuccessful. The guy was a really big and strong guy, and i am maybe 100 pounds soaking wet. He was extremely agitated..they had just put in a femoral cath and started him on CRRT, and he was very sick and confused. Nerologically, he was unaware of what was going on..all he knew was that we were trying to shove things down his throat, and he didnt like it. Needless to say, i ended up straddling him and the bed..i was kind of hanging there on him..he kept gagging and spitting and vomiting on us..well me mostly. We tried the water/ice trick (he refused to swallow), we tried to numb his throat, everything. Finally, i remembered that he liked strawberry ice cream...alot. The doc said we coud try to trick him by giving him a bite, them quickly getting the tube in while he swallowed. It worked, although that finally got done on night shift so i wasnt there. I was next to last semester in school..i felt like i failed until i realized that everyone on the floor was unable to get it. I graduate in 2 weeks, and still havent had another oportunity. The thought of it makes me shudder....

It happens! I always feel better when others miss too. LOL I've went down the wrong tube before- it was a psych pt, OD, about 300-350lbs who refused to cooperate and drink the charcoal. There was at least 6 of us in that room, she kept coming out of her restraints at that. She started turning red and looked a little more panicked, I pulled it out, and she started screaming she couldn't breath (everything else pointed otherwise).

She drank the charcoal when we asked if she was ready to try again.

LaceyRN · Dec 1, 2008

Well, I have placed 3 NG tubes during my ICU experience as a student and my recommendation is LOTS and lots of lube! and a twisting motion as you advance the catheter also helps. If the client is able and it's not contraindicated, they can swallow sips of water too. :)

allnurses Guide · Dec 1, 2008

I always use the small tube of lidcaine jelly, 5cc. Put some on the tip of your little finger (gloved of course :) ), gently slide the finger into the nare to numb up the skin, and also let you feel the anatomy, so you know where you will slide the tube. You can't do this with long fingernails! If they have a lot of dried mucus or whatever, you can clean out a little too. This helps avoid the blind poking and searching for where the nasal opening is, you already have an idea by feel, and the lido has had a chance to numb the back of the nose. Use the rest of the lido to lube the tip of the NG.

Have the patient sit up, when you are past the back of the nose, have him tuck the chin down a little while sipping water.

Know how far down you are planning to pass the tube, always alway measure ear to nose to gut: are you going for the first, second or third black mark? If they are yelling at you, you aren't likely to be in the lung :yeah:

britgirl37 · Dec 1, 2008

Ok, I was given a strange tip once, but I have to confess, ever since I started using it I haven't failed an NG insertion. When attempting NG placement, a pt will invariably close their eyes as part of fighting the whole process - encourage the pt to keep their eyes OPEN and for some reason, the tube seems to go down easier. Works for me!!

Mommy_of_3_in_AL..RN · Dec 1, 2008

I like the lidocaine suggestion. Never thought about that. Good idea! This guy was restrained too, but because of his condition, was unable to have the HOB raised, and sure as heck was not going to swallow on command! We were just hoping that he would scream enough that he would have to eventually swallow..never timed it right though.

The other thing..I am about to graduate and have never placed a foley. Never had that opportunity. Always worked somewhere where they were already there..any suggestions on that??? And how dumb am i going to look when i get out into the work force and cant do it..or better yet dont remember how?

Daytonite, BSN, RN · Dec 2, 2008

http://www.icufaqs.org/ngtubes.doc - n/g tubes for beginners

PeachyERNurse, BSN, RN · Dec 2, 2008

OMG! The worse thing a doc can say to me is "so and so needs and NGT." I freak. I'd rather do ANYTHING but that. Because I suck so bad at putting them in. In fact I've never successfully put one in. The last one I tried came out of the poor woman's mouth and she was gagging and crying. Traumatized the patient and me both! None of the tricks work for me. Tried to have patients swallow water, but I guess it's kinda hard to swallow when a tube is being shoved up ur nose and down ur throat:o.

crb613, BSN, RN · Dec 2, 2008

I love to put ng's down!

explain procedure

measure 1st & have everything ready

I curl the tube around my finger a couple of times

have them sit up straight (if possible)

find the most open nare

lube it up really good

chin to chest....water in hand with straw

aim toward the ear & rotate a little

when they gag....swallow, swallow, swallow

advance, advance, advance.

check placement...can they speak.

Now putting an IV in a baby......:barf01: