Had a pt with a husband who wrote EVERYTHING down. (Don't you love those.) Intubated/sedated/OGT. Giving her a med through the OGT like I always have -- take the open syringe, hook it up to the med port, hold it up around chest level, pour in my cup with the med and water, watch it go down, lift up a little if it's going slow, then pour in fresh water to flush.
Husband was floored. "I've never seen anybody do it like that!" he said. "They always push it in with the plunger."
I'll be honest, I've taken care of maybe 25 NGTs in my career before hitting the unit. I always did it this way. Here I've used the plunger once, because it was kinda stuck and my preceptor told me to. I also use it when I check residuals, and to return the residuals. (And for placement checks after inserting.) But I never felt comfortable using it for med administration.
Am I weird/overly cautious? Obviously if the tube's clogged all bets are off, let's get that sucker going. But if it's flowing freely, does anybody else skip the plunger?
I usually assume people who use gravity method come from a long term care facility background. I precepted and was hired into the ICU as a new grad, I was always taught to use the plunger with syringe. If your vent patient starts to have a bronchospastic cough or anything like that your open flow method turns into a geyser of mess all over you and your patient.
EXACTLY. If the patient's been tubed or pegged for a while, and has like scheduled bolus feedings I let gravity take it in. IF they're freshly ng'd/og'd/ Peg'd... I slow push with a plunger, because If they start ralphing, I want to aspirate all of that out IMMEDIATELY.
In my practice on a high - acuity med/surg floor (we take weaning vents, diltiazem/heparin/insulin/Lasix gtts, tele/nstemi pts) meds are pushed w a 60cc toomey no matter the tube placement. Obviously slow push and be aware of pt condition.
The only time I've gravity fed someone was to teach their family how to do it at home. Otherwise bolus feeds are hung through a gravity bag, or run through a moog pump.
Oh'Ello, BSN, RN
226 Posts
EXACTLY. If the patient's been tubed or pegged for a while, and has like scheduled bolus feedings I let gravity take it in. IF they're freshly ng'd/og'd/ Peg'd... I slow push with a plunger, because If they start ralphing, I want to aspirate all of that out IMMEDIATELY.