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OG tube securement, or NG?

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by JBMmom JBMmom, MSN (Member)

JBMmom has 6 years experience as a MSN and works as a Nurse.

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For your intubated patients, are OG tubes taped to the ET tube or secured in another way? We have nurses doing it both ways on our unit and they're all sure it's the best way. Some say taping to the ET tube is a problem because if the patient can pull the OG tube, the ET could be dislodged. For the ones that are attached with a tie, they often stay in the same place and could cause pressure sores, where taped to the ET tube, at least it is rotated regularly to alleviate pressure. I have wondered why we don't drop more NG tubes? At least when the patient is extubated with a NG tube, we still have access for meds and enteral feeds. Especially if a patient is extubated Saturday morning and speech won't eval until Monday for PO intake. I've looked for references, but haven't found much information. Would appreciate any feedback, especially references I could print for discussion on the unit.

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Okami_CCRN has 4 years experience as a ASN, RN and works as a Registered Nurse.

13,991 Visitors; 789 Posts

If a patient is intubated we usually insert an OGT and secure it to the ETT using clear tape (transpore) so that the markings on the ETT can be visualized easily.

Some of the literature out there shows that NGT in intubated patients had an increased risk of sinusitis associated with insertion and maintenance. 

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TooManyCats has 1 years experience.

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We secure our OG tubes to the ETT using paper tape (our unit doesn’t have Transpore on hand). Occasionally we will get an intubated patient from OR or from a previous unit with an NG and we will leave it, but I prefer OGs because of decreased skin breakdown risk.

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chris21sn has 3 years experience as a BSN, RN and works as a MICU/CTICU.

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We secure OG tubes with intubated patients. Nurses on our floor do either or. For me? I prefer securing it to the ETT tubes but the Respiratory Therapists hate it, so many nurses secure it on the cheek with tegaderm. I notice that it is better secured on the ETT (so that's what I usually do) - especially if the patient is pushing it out with their tongue. 

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JBMmom has 6 years experience as a MSN and works as a Nurse.

1 Follower; 11,381 Visitors; 678 Posts

Thanks for the feedback. Unfortunately, I have not been able to find much in the way of evidence based practice for this question, but I appreciate the responses.

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13,886 Visitors; 824 Posts

We secure to ET tube with clear tape. The trauma docs don’t like it because (as stated above) if the pt pulls the OG they’ll displace/pull the ETT. So far I have never had an intubation patient pull at their OG...if they’re going for a tube you can bet it’s the ET.

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So during a mock Magnet survey, we were told not to secure OG tubes to ET tube for the same reason listed above. I haven't been able to find any EBP data on this topic either. However, I agree if they are going to pull at something it will be the ET tube and if the ET tube comes out then so should the OG tube. Anyway, has anyone else found a good safe place besides the ET tube?

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ptier_MNMurse has 3 years experience as a BSN, RN and works as a CVICU RN.

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On 4/26/2019 at 3:18 PM, JBMmom said:

For your intubated patients, are OG tubes taped to the ET tube or secured in another way? We have nurses doing it both ways on our unit and they're all sure it's the best way. Some say taping to the ET tube is a problem because if the patient can pull the OG tube, the ET could be dislodged. For the ones that are attached with a tie, they often stay in the same place and could cause pressure sores, where taped to the ET tube, at least it is rotated regularly to alleviate pressure. I have wondered why we don't drop more NG tubes? At least when the patient is extubated with a NG tube, we still have access for meds and enteral feeds. Especially if a patient is extubated Saturday morning and speech won't eval until Monday for PO intake. I've looked for references, but haven't found much information. Would appreciate any feedback, especially references I could print for discussion on the unit.

In our facility we tape the OG tube to the ETT. We have tried to stay away from placing NG tubes more so to reduce the incidence of pressure injuries related to nasal bridles and large french tubes going into someone's nasal cavity causing increased risk for irritation, bleeding, and injury. Some of this has to do with how tightly the nasal bridle is brought up to the columella of the nose, which can cause injury (so in part user error).

Regarding the risk of sinusitis in patients with an NG, I think that is valid, however, anyone who is intubated and mechanically ventilated has an increased risk of sinusitis, and subsequent pneumonia. This is also why we do VAP prevention. I have a couple of articles detailing this below. While I think that NG placement increases the risk for sinusitis, I do not know the significance of this factor.

https://www.ncbi.nlm.nih.gov/pubmed/8874069

https://www.ncbi.nlm.nih.gov/pubmed/2048700 (read conclusion)

About pulling an ETT and leaving an NG tube; this is doable, but depending how long the tubes have been in, the patients anatomy and how the placement went, I have found that the OG/NG tube often gets wrapped around the ETT. Even if you have a small PPFT/NJ tube in and place the wire down again to "ensure" the tube won't come up during extubation, I feel that more often than not the OG/NG/PPFT/NJ tube comes up and out of their mouth. I have more than once had to quickly snip a nasal bridle and pull the NG/PPFT/NJ because the distal tip of the tube is hanging out of their mouth and sitting on their chest. So while it does work sometimes, nasal route is not always a guarantee for definitive gastric/post-pyloric placement when extubating.

As far as not taping the OG to the ETT to decrease risk of pulling the OG tube and inadvertently pulling the ETT out, I think there are some other issues that would need to be addressed. Generally, people don't have a policy or opinion on things unless they have seen something bad happen because of it... So I would guess that someone has had an ETT pulled when a patient got ahold of an OG tube secured to it... Personally, I have never seen that. While my patients are waking up and pressure supporting and working toward extubation, I have them placed in soft restraints. If a patient is pressure supporting for longer periods of time to try to workout their lungs, I either have them in restraints, or I have them in safety mitts, or I am at the bedside and watching them to ensure they are not getting agitated to the point of pulling tubes out. So I guess I think there are a few other considerations to be taken into account when rationalizing this.

Your last question about speech/swallow evaluations for getting your patients to eat something or take pills or what not, Have you considered implementing a nurse bedside swallow evaluation tool? Here is a random one I found, but there are a lot of other tools you can use that are often integrated in your charting system. But here is an example:

http://aann.org/uploads/Bedside_Swallow_Screen.pdf

Hope this helps!

Cheers!

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JBMmom has 6 years experience as a MSN and works as a Nurse.

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Thank you so much for your response, I appreciate your time and will definitely bring up some of the points. I have asked about bedside swallow eval and generally we've been told that it's beyond our scope after intubation in most cases. The speech therapists are the experts in that area.

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