Nursing 10 years ago

pebbles, BSN, RN · Jun 16, 2007

:redlight: For info . In school of nursing they are still teaching air bolus to check the N/G tube placement. And also to check palcement via aspiration of gastric juices to check ph and placement is not very reliable as even if the aspiration shows that the acidic that does not mean it is not in the stomach as it can be the residue of fluid in N/G tube. Therefore in my experience the most reliable would still be the air bolus test as you would physically ausculate the stomach and listen for the sound of the air being intrioduced into the stomach via the N/G tube. Of course, there has been a research lately that doing CXR would be the most accurate.
Unfortunately I feel that it would not be very feasible as in a home siuation and also very costly to the patient.

Studies have consistently shown that you cannot tell the difference between stomach and lung from an air bolus auscultation. Two pts in my facility died after being tube fed into the lungs. I will still believe that aspirating what is obviously stomach contents (and a good enough amount that it wouldn't just be residual in the tube) is the "best practice". If you cannot tell after aspirating, for pt safety you must get an x-ray.

That is the policy we use for feeding into an NG. For draining, it's less strict.

I can't imagine too many situations where a pt is at home needing to be tube fed via NG. Would the pt not benefit from a PEG or a small-bore feeding tube into the duodenum instead? (small-bore feeding tubes always need to be x-rayed)

angel's RN · Jun 16, 2007

In our hospital, I have seen one nurse not even check for NG placement (and I have reported them--s/he isn't there anymore!!). When I drop a NG, I mark the line at the nose with a BIG permanant mark, then use Mastisol and bandaids to secure it. Of course, I aspirate contents and check with air bolus, too.:roll :roll Double work? Maybe, but WELL worth it!!

's RN

chrissoo · Jun 16, 2007

Studies have consistently shown that you cannot tell the difference between stomach and lung from an air bolus auscultation. Two pts in my facility died after being tube fed into the lungs. I will still believe that aspirating what is obviously stomach contents (and a good enough amount that it wouldn't just be residual in the tube) is the "best practice". If you cannot tell after aspirating, for pt safety you must get an x-ray.
That is the policy we use for feeding into an NG. For draining, it's less strict.
I can't imagine too many situations where a pt is at home needing to be tube fed via NG. Would the pt not benefit from a PEG or a small-bore feeding tube into the duodenum instead? (small-bore feeding tubes always need to be x-rayed)

Thanks for the advice . But I in my place of practice not all relative of patient are keen for PEG insertion

katfishLPN · Jun 16, 2007

The advent of DRGs in the 80's, which influenced approved length of stay in hospitals totally wreaked havoc on acuity levels. Computers in our part of the country are pervasive, and they were only used for order entry 10 years ago. The approach to Health Care as a "business" managed by people who have no training or experience in Medicine is probably the worst thing. That would bring us back full circle to the approved LOS!:uhoh21:

I did a paper on DRG's when I was in nursing school. I graduated in 1989. I learned a lot about them but for the life of me I can't remember what it stands for. Duh!!:smackingf I am entering early senility I think. There were no computers around where I was anyway. When I first started in nursing we didn't wear gloves and universal precautions hadn't been "invented" yet. Used heat lamps for bedsores. :uhoh3:

katfishLPN · Jun 16, 2007

Haha! Beats me! That is why I chose it, but I think he's just dancing

Ya looks like YMCA to me. Maybe you aren't old enough to remember that. "It's fun to stay at the Y-M-C-A." The song is called "YMCA" by the Village People?

fronkey bean · Jun 16, 2007

NO! it is a sterile procedure. I have seen a lot of this attitude as well and it probably accounts for the huge number of UTI's that develop in the hospital. A patient cathing themself intermittently in their own home is a "clean" procedure.

we've had a few of those home pt's come in w/ raging UTI's

angel's RN · Jun 16, 2007

You guys keep talking about getting the hospitalists involved or whoever.....you gotta remember that not all of us are in big hospitals with hospitalists and specialists at your fingertips. Little dinky rural hospitals are doctorless in the off hours except for the ER doc, who has nothing to do with inpts unless they're actively coding. In any other situation you gotta get the PMD on the line and get them in asap.
And every EKG machine I've ever worked with has the computer program to interpret EKGs, but like people they are not infallible. Not often wrong, but often enough that it cannot be depended on.

:bugeyes: Hey Taz--

You must work in the same small rinky-dink hospital I work at!! :lol2: :lol2: :lol2:

's RN

KYCNM · Jun 16, 2007

I did a paper on DRG's when I was in nursing school. I graduated in 1989. I learned a lot about them but for the life of me I can't remember what it stands for. Duh!!:smackingf I am entering early senility I think. There were no computers around where I was anyway. When I first started in nursing we didn't wear gloves and universal precautions hadn't been "invented" yet. Used heat lamps for bedsores.

The term is diagnostic related groups.

KYCNM · Jun 16, 2007

In our hospital, I have seen one nurse not even check for NG placement (and I have reported them--s/he isn't there anymore!!). When I drop a NG, I mark the line at the nose with a BIG permanant mark, then use Mastisol and bandaids to secure it. Of course, I aspirate contents and check with air bolus, too.:roll :roll Double work? Maybe, but WELL worth it!!
's RN

Angel, by doing all this "double work" you will never find yourself on the wrong end of a lawsuit and have the uncomfortable experience of "defending" your practice.

smk1, LPN · Jun 16, 2007

we've had a few of those home pt's come in w/ raging UTI's

I believe it! people are rinsing and reusing caths and just aren't that "clean" to begin with lol. The idea is that the germs around your home are germs you are already exposed to and maybe not as harmful to you because of the constant exposure. In the hospital there are too many other germs and if you are in the hospital you may be immunocompromised anyway, so keep things sterile.

katfishLPN · Jun 17, 2007

The term is diagnostic related groups.

Thank you!!

angel's RN · Jun 17, 2007

Angel, by doing all this "double work" you will never find yourself on the wrong end of a lawsuit and have the uncomfortable experience of "defending" your practice.

That is very, very true. I actually had to defend myself in a deposition once----- but that is for another time and place!!

's RN