OG tube aspiration with ET tube in place?

PostOpPrincess, BSN, RN · Oct 23, 2009

Technically speaking, theoretically with the ET tube in place, it is NOT supposed to. There is a cuff and, if the trachea is normal, it would be inflated enough to protect the airway without causing tracheal malacia.

HOWEVER -

Doesn't always come out to be true. I have seen it happen and I've seen the tube curl up in the back of the throat.

If in doubt, the best thing to do is to take the og-tube out.

And it does sound like she aspirated, especially when you suction and there is foodstuffs in her lungs.

How does the x-ray look?

mamamerlee, LPN · Oct 23, 2009

They can aspirate - reflux from the feedings can end up in the lungs, even with the tubes correctly placed. Aspiration pneumonia. HOB must be elevated while on Tube feedings.

PICNICRN, BSN, RN · Oct 23, 2009

Did she have a leak? Did you check a cuff pressure? The cuff is not always inflated as much as it should be, but does not cause problems with ventilation so we don't worry about it. And even if it is, like the above post says, the OG can migrate with coughing and such.

We usually place our OGs as "OD" tubes- transpyloric to avoid this. Sounds like she aspirated... sad.

shiccy · Oct 23, 2009

The important thing, really, is that this was caught and caught early. Luckily she was not extubated, because if she was this probably would have made things much worse and/or she would have just had to have been reintubated a second time.

Take things like this as a learning experience... it's always important to check things like placement and residuals from tube feeds regularly.

One thing that I do want to point out is that certain pneumonia's have the ability to mimic the color of tube feed ... I've seen it a couple of times myself, especially on a few patients that have not had tube feed and are on TPN, so just keep that in mind.

Also a thing to remember is that while it did cost this patient an extubation, just remember we all have the ability to make mistakes. Remember not to place blame, and while charting, just state the facts on what you found abnormally and what you did to correct it.

hallk008 · Oct 23, 2009

They did the chest x-ray at 6 am and it said the tube was in her stomach, but her nurse bathed her and repositioned her after that, so that might be when it happened. My shift starts at 7. Respiratory came in and checked the cuff pressure and she said it did need inflated a little bit. Her nurse did tell me when I was giving her report last night that she could have aspirated when they layed her flat. Maybe she forgot to put the feeding pump on hold. I don't know, but I do know I heard the air coming from around her ET tube. I'm so confused about all this lol.

CASTLEGATES · Oct 23, 2009

Oh crap! That's what I think when that happens! Hate it!

yeah, they can aspirate with a fully inflated cuff (it's not perfectly airtight; think about it...tissue and a plastic balloon and liquid above it--only a matter of time till something seeps down).

I'd tattle on the patient (call the md, get a coworker to double check) especially if the plunger is responding to pressure, then I'd say it's done.

Also check the vent readings for the fun of it and you'll see some air and peep lost.

I always double check for aspiration to see stomach contents, though...do a ph test if you're till not sure but if you've got that much in the lungs, maybe call clergy :redbeathe

I hate it when that happens! Hope they survive!