NG Tubes

[CapeCodMermaid, RN]

Do any of you manage NG tubes in your facility? I've never been in one where it's been allowed. My current company thinks it's a great idea...I think it's not.

To top it off...IV Lasix, IV Solumedrol, IV push meds...1 nurse for 20 residents. What are the other 19 supposed to do while the one nurse in pushing lasix and then monitoring the resident? Crazy.

[brownbook]

I'm confused. Your residents have IV's, thus you give IV meds. Now the company wants residents to have NG tubes?

What is the reason for the NG tubes?

I assume in your haste to post your question you meant the residents have NG tubes, and now it's the company wants residents to also have IV's if ordered?

I may be wrong. Please explain.

[CapeCodMermaid, RN]

I wasn't posting in haste. We've been doing IV therapy for years. There is a difference between hanging a bag of fluids or antibiotics and pushing meds.

The NG tubes- they want us to take people from the hospital who have NG tubes. No one who actually works the floor thinks this is safe. The tubes can easily become dislodged and we can't see any clinical reason for having them.

[marienm, RN, CCRN]

I think the biggest question with NG tubes would be: what are you supposed to do if it comes out? Do you have in-house Xray & radiology to verify placement of a new one? Or would you have to send the resident to the ED to do this? Or would they want you to just drop a new one (not always easy in the first place, even with a cooperative patient) and then aspirate to confirm placement? (I work in a hospital and we are not allowed to give anything via an NGT without X-ray confirmation, although we are allowed to hook them up to suction for decompression. But if, later, that same tube we've been using to suck out green bile for 4 days is going to be used for feeding, we need an X-ray!)

Also, how long do they propose these patients have an NGT for? They can cause pressure ulcers in the nose and sinus infections in some cases. Having a tube for a week post-hospital might not be terrible, but any longer than that and they should probably have a surgically-placed tube. What would be the criteria for removing it and who would decide? Also, what size/type of tube are they thinking? Managing an 18Fr NGT is pretty much the same as manipulating a G-tube, but managing a 10Fr tube (whether it's gastric or post-pyloric) means taking a lot of care to really crush all meds, because those tubes clog easily! (And if it is post-pyloric, no bolus feedings!)

[CapeCodMermaid, RN]

You're preaching to the choir... it's a stupid idea.

[brownbook]

What type of facility is it?

Thirty years ago in a skilled nursing facility I floated to every patient had an NG tube and the nurses refused to take patients with IV's.

I worked nights so I don't know how awake or active the patients could be, but they were generally debilitated elderly patients.

That's where my confusion came from.

Do you know why someone wants patients to have NG tubes?

[CapeCodMermaid, RN]

Because the census is down. Because they want to be different. Because the people making these decisions have no clue what it's like to be a staff nurse

[caliotter3]

I saw one NG tube when I worked in LTC. I was almost a brand new nurse and tiptoed around that resident because, as usual, I also had only one NG experience in nursing school. I dreaded the possibility of a problem. I cheered up when the tube was removed.

[vintagemother, BSN, CNA, LVN, RN]

Because the census is down. Because they want to be different. Because the people making these decisions have no clue what it's like to be a staff nurse

I have worked in a SNF or 2 that wanted to increase census by allowing sicker pts with more needs than the staff was qualified / trained to work with. I think I understand your concern, CapeCod.

I now work in an acute facility and have observed pts that are having a hard time being discharged due to a lack of facilities that accept the type of needs the pt has.

It's a problem.

The solution...I don't know. This is the way of the future due to insurance companies dictating when a pt has to move to a less acute form of care.

As far as solutions...offer very robust training to the staff prior to giving them these types of pts. And make sure a person or a well written policy is in place to guide staff when problems/questions occur.

[brownbook]

I have worked in a SNF or 2 that wanted to increase census by allowing sicker pts with more needs than the staff was qualified / trained to work with. I think I understand your concern, CapeCod.

I now work in an acute facility and have observed pts that are having a hard time being discharged due to a lack of facilities that accept the type of needs the pt has.

It's a problem.

The solution...I don't know. This is the way of the future due to insurance companies dictating when a pt has to move to a less acute form of care.

As far as solutions...offer very robust training to the staff prior to giving them these types of pts. And make sure a person or a well written policy is in place to guide staff when problems/questions occur.

Great response, I completely agree with you.

[dream'n, BSN, RN]

They want to take acute med-surg patients, but not provide med-surg nurse ratios.

[CapeCodMermaid, RN]

Exactly...IV Lasix..IV Solumedrol...too much for the staffing ratios we are forced to deal with.