Re: NG tube irrigations

Genista, BSN, RN · Sep 3, 2003

Your hospital should have a policy & procedure (P&P) manual for you to use. Believe it or not, policies do vary from facility to facility. There isn't some universal nursing standard for each procedure (it's many shades of grey in fact). Books are a great reference, but you should probably look at hospital policy first. If you question your facility's policy, then perhaps it should be brought up for review. Policies need to be updated periodically. If I can't find it in the P&P, then often I will call on my more experienced peers or my house supervisor for help. When I'm on the job, I often don't have time to surf the net & I need a quick answer, STAT. Many units also carry a basic med surg skills text with standards and rationale, such as Lippincott's Med Surg text.

Tweety, BSN, RN · Sep 3, 2003

I guess it depends on what you mean by irrigating. Just a routine flush can be done with water for what I've seen and what I do. During routine assessments of patients with NGT's I irrigate with 20 or so cc's of water, just as a routine, don't know where I picked that habit up. (After checking for placement with air of course).

But an lavage where you're continuously irrigating large amounts0 for a gastric bleed, I've seen done with only saline. Again, don't know where I get that from, just experience. Thanks for the information and followup.

gwenith, BSN, RN · Sep 3, 2003

If you are just looking for a good policy resource then the Joanna Briggs Institute is very well thought of.

It is an institution dedicated to evidence base practice and containd "practice guidelines based on EBP. However the number of these is still limited.

http://www.joannabriggs.edu.au/about/home.php

nowplayingEDRN · Sep 3, 2003

Gastric lavage is done with NSS, and I prefer sterile H2) or NSS for a post op irrigation (at least if there is a leak it is sterile solution going into the peritoneal cavity).

A good source for procedures (besides your hospital's SOP book) is AACN's procedure manual. That is what we use when our facility has no SOP on a certain procedure.

rstewart · Sep 3, 2003

I am assuming that the original poster's question refers to the routine maintenance of an NG tube post-op; (ie. What solution should be used to keep an NG tube patent when hooked up to suction?)

This question strikes a chord because several years ago I was chastised by a charge nurse (What nursing school did you graduate from etc.....) when I was observed irrigating an NG tube with warm tap water to maintain patency. I was given a lengthy potential for severe electrolyte imbalance lecture.

Our policy and procedure manual was silent as to the proper solution, however, that brings me to my first point: Just because something appears in a policy and procedure manual does not necessarily mean there is scientific research which supports the practice. In no way do I mean that it is appropriate to disregard such manuals when performing procedures. But one should not assume in nursing that because a practice appears in many procedure manuals that there is evidence to support that practice. Indeed that is the "meat" of the evidence based practice movement; many of the practices performed by nurses were based upon custom rather than research.

In any event, I performed a search in an attempt to find a single study which demonstrated that recommended (small) irrigation volumes/frequencies of warm unsterile tap water would disturb electrolytes or otherwise potentially adversely affect the patient when instilled into the already non sterile GI system. I was unable to find such a study.

What I WAS able to find was an article in one of the major nursing journals which suggested how much money could be saved annually in a large facility by using tap water rather than NS. (I wish I could properly cite the author.)

Using that single authoritative source (but still without solid evidence pro or con) I proposed a revised policy and procedure specifying tap water as an acceptable irrigant for routine maintanance which was eventually adopted. Additionally, I received an award based on the cost savings achieved by eliminating the NS and certain supplies.

But the best reward was later reminding the charge nurse to use tap water per our P&P manual. Old habits do die hard.

purplemania, BSN, RN · Sep 3, 2003

for the life of me I cannot see how NS could alter electrolytes more than any other liquid. Unless it is an infant, surely the volume would not cause an imbalance. Right??

Marie_LPN, RN, LPN, RN · Sep 3, 2003

It can alter the electrolyte level if that's what they are having a problem with in the first place.

Certain cases of hypernatermia the Dr. has ordered sterile water on our floor.

rstewart · Sep 3, 2003

You know I forgot there is one class of patient we get in critical care for which the use of sterile water does have some evidenced based support: those who are severely immunocompromised. Hospital water has been implicated in nosocomial infections due to biofilm buildup and corrosion in the lines.

renerian, BSN, RN · Sep 3, 2003

That is nice if your in a facility with lots of supplies. In home health there is nothing but tap h20 and of course no money to buy anything else.

I can see in the immunocompromised host.

renerian

almukbali · Sep 3, 2003

Hi, i'm from Deferent country, what we are practicing right now is similar to what some friends mentioned. That we are using water in the routine flush but in case of Gastric lavage where is a gastric bleed, we are using cold normal saline.

almukbali

Oman

JMP · Sep 4, 2003

We use sterile water, since all of our pts are intubated, risk of mirco-aspiration with tap water is too great.

Third shift---- we no longer as of last year check NG placement with air. Research proved it not to be reliable. We check every NG or feeding tube with Xray and every nurse is now required during the inital assessment to document the NG placement by charting what "black dot" it is taped at....example ..... NG left nare, taped at 3rd black dot at the nare, feed running Jevity at 75cc, residuals 15 cc.