NGT placement

It is standard to get a portable KUB (in addition to auscultation) after NG placement at our facility if the tube is going to remain in place. If they don't order one I always ask and have never had anyone tell me no. However, in the ER if they are not planning to leave the tube in it may be a different situation.

In your situation, is it possible the tube was pulled during transport or transfer to the CT table? Since the scan showed it in the proximal esophagus, this would be my suspicion.

Those Radiology types are very well known for pulling anything out thats attached to a patient. IVs, Foleys, NGTs, etc If it can be pulled they will pull it and then try to say it was already like that.

Thats normal behaviour for them

http://www.enw.org/Research-NGT.htm

This site is pretty comprehensive about placement

Hi. I work as an enteral feeding nurse specialist in the UK. It has recently become UK law that NGT placement can only be verified by either x-ray or pH testing. Because x-ray is obviously not possible each time to check the possition, we recommend that you obtain an aspirate, which measures pH 0 - 5.5. The reason for this is that bronchial secretions have been known to measure 6.0. The problem arises if the patient is receiving PPI therapy or antacid medication, which renders the test possibly obsolete. If you would care to check out current UK legislation, search for the MHRA on line, which sets our directives. Good luck.

Those Radiology types are very well known for pulling anything out thats attached to a patient. IVs, Foleys, NGTs, etc If it can be pulled they will pull it and then try to say it was already like that.

Thats normal behaviour for them

:rotfl: :chuckle

Eh HEE HEE HEE!!! :rotfl: :rotfl: :rotfl: :rotfl:

has anyone ever seen an NG tube come out the mouth? I was assisting an RN who kept putting the tube in this man's lung, and then it came out his mouth....it was aweful!!!!

I would also add that if you lavaged 250 ml's of fluid into his esophagus, you would have seen either a backwash of fluid out of the pt's mouth or a desat as he aspirated all that fluid.....my bet is that CT pulled it.

I saw a new rn out a Salem Sump in the right nare and then she freaked as it surled and came out the left nare. She freaked over that.

I saw a new rn out a Salem Sump in the right nare and then she freaked as it surled and came out the left nare. She freaked over that.

Even now that I have placed countless NGs, I still get the "ew" feeling in the pit of my stomach when I have to do it. I'm just always waiting for the pt to vomit....and I still have an irrational fear of placing the tube into the brain :)

I can understand freaking out as a new RN if you had never seen the NG snake through the mouth. In school, many students never get a chance to place one on a real pt, only in mannequins, and nothing ever goes into the wrong place on mannequins!

In answer to the initial question, I was taught in school that the only "true and acceptable" ways to verify tube placement are GI aspirate w/ pH test, and radiology. In practice, we simply verify placement by auscultation, then an eventual KUB (I'm in the ED). I don't think you did anything incorrectly...most likely it was yanked!

Even now that I have placed countless NGs, I still get the "ew" feeling in the pit of my stomach when I have to do it.

I do too it's the same feeling I get when I have to restrain an out of control confused elderly person...ugh Feel so bad for them. I have yet to send a NGT into the trachea but have had a couple come out the mouth and have had many throw up and most gag of course. The more you do the easier they get though.