Pt with both nasal cannula and NG

[anon456, BSN, RN]

I'm a new grad nurse who has finally landed a job! :-) I'm working in pediatric home health and have been assigned to a young patient who has both an NG and nasal cannula O2. I have not met the pt yet.

I'm just having trouble visualizing this since the NG would be getting in the way of the cannula. And how does the patient get effective O2 with the NG tube partially blocking the nasal passage on the one side?

One other related question- this child is very grabby and likes to mess with the tubes on their face. I know that distraction works up to a point but if a child is determined to mess with them, it's going to be hard even with one on one care. (My experience caring for my own children has taught me how determined they can be!) What is a good strategy to prevent this without using elbow restraints and allow the child to move freely to enhance development?

[akulahawkRN, ADN, RN, EMT-P]

As to the NG and NC issue... it'll be OK. The kid's likely going to be on a low concentration and that means a pretty low flow. The partial occlusion won't really be much of an issue as the nasal cavity is much bigger than the NG tube is. You might have more of an issue keeping the tubes from tangling in each other than anything else. Pedi cannulas are also pretty small, so you can probably get them to work out without too much trouble.

As to the rest of the issue of the kid messing with the tubes... no idea. I haven't worked with peds that much. The ones I did work with (every great once in a while) were so developmentally challenged that they needed restraints anyway. I doubt that the kid you'll work with will need that much management to make things work out.

[smurfynursey]

As far as the NC and NG, I agree with the previous poster. Its not as big of a deal as it may seem. As far as pulling goes, we use the out of sight out of mind idea, tape the NG so that it is almost to the pt's ear and thread it down the back of their shirt, and do this with the O2 tubing as well. Also, eventually (hopefully) the child will come to associate the cause/effect of pulling the tube (needing it replaced) and will stop for the negative experiance of it. I have a kid at work that likes to pull himself off the vent at night, for that we put a onesie on him and then another one over the tubing so he cant get to it as easily. Another option is to put socks on his/her hands, though we dont like to do this unless its ABSOLUTLY nessacery. My facility doesnt consider it a restraint unless the socks are taped on.

Do you know what the developmental level of this kiddo is? Is he/she a child with complex issues, or something simple (er)? That will make a big difference.

Good luck with your job! I did/do pedi homecare and have grown to love my kiddos :)

[MKS8806]

How old is this kiddo??

I had a 5 day old last week that had both an NC and NG. As previously posted, socks or mittens are good for little ones that are grabby. If it is an infant, I would encourage swaddling and really getting those hands tucked in.

Also, as the others said, NC and NG are fine together. If the kid needed high concentrations of O2, they would not be on an NC.

[NeoPediRN]

I've taken care of babies with an NG and high flow, as well as CPAP and BiPAP, no problems with it at all. The size of the NG relative to the nare is pretty small, and remember that we breathe predominantly out of one nare at a time. The key is to use saline if they start getting upper airway congestion. Good luck!

[tryingtohaveitall]

i've taken care of babies with an ng and high flow, as well as cpap and bipap, no problems with it at all. the size of the ng relative to the nare is pretty small, and remember that we breathe predominantly out of one nare at a time. the key is to use saline if they start getting upper airway congestion. good luck!

i've never heard this. can you elaborate or show some links? thanks

[NeoPediRN]

http://www.ncbi.nlm.nih.gov/pubmed/1904408

You can also google "nasal cycle" :)

[tryingtohaveitall]

Thank you. I'd never heard of that. Just goes to show you can always learn something new. I found a newer article in CINAHL whose study showed a nasal cycle was rare in infants. Very interesting, thanks!

[NeoPediRN]

I read that one awhile back. It seemed to be a small isolated study. I tried to find more data to back that up but was unable.