NGT Inserted Into Lung

[MomRn3]

Inserted an NGT for SBO and the pt began to desat after insertion. Removed immediately and pox returned to baseline. This has never happened to me and I'm freaking out. My anxiety is on overdrive now. The Dr said it happens and wasn't too concerned. 

Has this happened to anyone else? 

[NRSKarenRN, BSN, RN]

Yes it has, patient survived experience 40 years ago. This was in the days of just listening for whoosh sound from air bolus in stomach upon insertion,  prior to standard of CXR or ph testing of aspirate to confirm placement.  When possible asking the patient to swallow during insertion helps to feel the tug of the tube as the epiglottis closes during swallowing and ease tube into esophagus.

See NG tube Xray misadventures  --less than 0.5 -20% of insertions per several sources.

Nursing Procedure:

Nasogastric Tube: Inserting and Verifying Placement in the Adult Patient

Kudos to your quick removal post desat as recognizing complication.  You will recover your confidence for next insertion as time passes  for you successfully delt with issue.

[traumaRUs, MSN, APRN]

Yep several times over the years - pts also survived. You were watching and aware of what was happening - you did well. 

[MomRn3]

My fear is injuring them. Lung damage.

Any injuries to those that this happened to? I talked to the Dr who went and saw the pt. He wasn't concerned. But my shift was over and I left.

Thanks everyone. Just hate when things happen. No other nurse there had had this happen except one older nurse.

[RNperdiem, RN]

Happens every once in a great while. Pt never had any injuries. Unless you are really roughly jamming that tube against resistance, lung injury is unlikely. 

You noticed the desaturation right away, removed the tube and the patient recovered, MD aware. You did all the right things. 

[Laura-Lee Nuttall, BSN]

It's happened to me. I also removed the tube right away. The patient was fine, but I still will trade away NG insertion for pretty much any other nursing task. 

[0.9%NormalSarah, BSN, RN]

I heard a story of a nurse inserting a post-pyloric tube into the lung and causing a pneumo. It's a risk, but I think pretty rare. You did everything right. I've also inserted a tube likely into the lung as evidenced by coughing and desaturation, pulled it back and then re-attempted. Everything was fine, and the post insertion x-rays looked great. Good job to you!

[Charles Barrow]

At your facilities, are patients or their representatives typically informed after an NGT is inserted into a lung?

[MomRn3]

The Dr went into the room and talked with them explaining that it sometimes happens.

[mdsRN2005, ASN, BSN, RN]

RNperdiem said:

Unless you are really roughly jamming that tube against resistance, lung injury is unlikely. 

You noticed the desaturation right away, removed the tube and the patient recovered, MD aware. You did all the right things. 

I agree.  And you should be proud of yourself for recognizing this and correcting it so quickly, thereby preventing injury to your patient!   
 

As to how to prevent this happening again, I agree with the person who said have the patient swallow.  Sometimes they are so anxious they forget!  I've found that it also helps to have them tilt their head forward (I always tell them touch their chin to their chest).  They forget this too, but I use my nondominant hand to apply gentle pressure to the back of their head to tilt it forward.  IMO this is the biggest factor to making the NG go down easily.  Also make sure they're sitting up straight not slumped or reclining.  I always raise the HOB til they're at a 90degree angle. 
 

Please don't stress yourself out or beat yourself up over this.  You made an honest easy mistake that is an unfortunate "side effect" of this procedure, much like a blown vein in a IV start.  It happens but you did do all the right things to take care of your patient.  Your patient survived and so will you!