NGT placement

[SHALIMAR]

I would appreciate advice on NGT placement. On a previous shift I placed and NGT tube without difficulty, varified by asculation at the epigastrum and had clear gastric return. The ER doc then requested lavage for blood, which I did, lavaging 250 ml NS and suctioning same amount, no blood. Later the Pt went to CT and it was revealed that the NGT was in the proximal esophagus. How could I have better varified placement?

[starae]

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.

[teeituptom, BSN, RN]

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

[ToryAdore]

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

This site is pretty comprehensive about placement

[rob5252]

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.

[SteveNNP, MSN, NP]

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.

[Happy-ER-RN, RN]

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:

[Spritenurse1210, BSN, RN]

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!!!!

[suzanne4, RN]

Very easy, but why was she trying to put an NGT into the lung, it is meant for suctioning the stomach or giving meds and tube feedings.

NGT stands for naso-gastric. If the patient doesn't swollow the tube, it will curve around and come out the mouth at times. Best bet is to have the patient hold their chin down to their chest and take a sip of water, if permitted. That will facilitate it going in the easiest and to the right place.

[jillyk*rn]

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.

:yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat: :yeahthat:

[teeituptom, BSN, RN]

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.

[RunnerRN, BSN, RN]

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!