NICU new grad NG tube insertion

[New_gradNICU]

Hi everyone! New grad NICU nurse here. Does anyone have any tips on inserting a NG tube in a baby? I feel no matter how many times I try I usually can never get it...I tried so many times and always feel like I'm hitting resistance instantly and the baby keeps crying so I feel really bad ? 

I was taught to use lube, angle the tubing downward and starting pushing towards the ear following anatomy. There was 1-2 times I did get it but majority of the times can't do it and have to ask for help. It's s so embarrassing to still not be able to do this on my own ? please any tips or advice is appreciated thank you! 

[marienm, RN, CCRN]

I am NOT a NICU nurse but I am sorry that you haven't gotten any replies :(  The thing I noticed you mentioned was that you angle the tube downward...in adults, I usually have the best luck pushing the tube straight back.  I generally try to drive it along the "floor" of the nasal cavity- with some patients if you get down level with their nose and a flashlight you can see it's a pretty straight path (not everyone, obviously!)  When it gets to about 10-15 cm it is usually past the turbinates in the nose.  By about 20 cm it's in the back of the throat.  But it's the patient's anatomy that makes to tube curve downward, not me angling it that way.  

The distances are probably different for babies, but is there a consistent place you're getting resistance?  Figuring that out might help you figure out an intervention that would help.  If it's in the first 1/5th (or so) of the length, the problem is in the nose so you need to figure out what part of the nose you're hitting.  The next part is the glottis, so if you're getting stuck there maybe you need to work on your timing of when to push vs when the baby takes a breath.  If you're getting resistance after you should be in the esophagus, the tube could be coiled (look in the mouth; if you see it, pull back the tube to "above the glottis" but not "in the nose" and try again).  Also, if you get someone else to place a tube for you, watch their angle and technique!

[Alexandrea Wheeler]

Instead of guiding it back at the base of the nose (bottom of the nose where the mouth is), insert at the top at the tip of the nose and push straight down at like a 45-60 degree angle. I saw someone do this once and it's saved me. The hole is a lot closer than you think. There's not much actual nose there tbh unless you're doing a term kiddo and even then it's pretty shallow like 1 cm on the NG tube if that. I tried to draw a blue line on a pic for you for the angle!

[offlabel]

yeah...go straight back, no angle.

[NYC Nicu nurse]

I have always had better luck if I initially hold the tube about two inches back from the tip and if there is any curve to the tube, hold it with the curve going down. When I insert and advance, I aim for the medial dorsal corner of the nare, so down and to the right in the left nare (“south east”) and down and to the left in the right nare (“south west). This works better for me that just aiming down. Just my anecdotal experience after 13 years of inserting NGs ?

[NICU_Nurse_Casti, BSN, RN]

Are you having difficulty with initial insertion? Like, you are struggling to find the nasal passage?