Secret to successfully inserting an NG tube?

CNL2B · Jul 27, 2010

I insert NGTs and small bore FTs all the time in the ICU. It's a blind insertion and should not be difficult if you get your technique right. Measure, insert to nasopharynx, head down and get the tube around the bend, get patient to swallow (with alert patients, I have found it works best to have them drink some water. Doing a dry swallow is a little more difficult), insert to your mark. Do it as smoothly and quickly as you can as long as you don't meet resistance -- it's not a pleasant procedure. Once you get proficient at it, it takes less than 5 minutes barring any weird anatomy/insertion difficulty. Practice makes perfect and the more times you do it, the better you will get at it.

It's a lot easier to do on patients that are sedated/neuro altered/somnolent/etc. If patients of that nature come to your unit and need NGTs, you might want to offer to do them. When patient's don't gag, grimace, sputter, eyes water, etc. it's a little easier to not be so tentative about doing it!

I don't ice the tube. Once you get proficient with insertion you may not need to either. When the tube warms up to body temp and gets a little more pliable is when insertion gets difficult. If you can get the tube down before it gets to that point, it doesn't need ice.

Our docs also allow us to use lido jelly to numb the nose up, which is a nice thing to do if you can get an order for it. I would not use chloraseptic pre-insertion because I have found that sometimes it makes patients have a hard time swallowing. You can use it afterwards for tube irritation, though.

Karen A · Jul 27, 2010

CNL2B is spot on with her steps. Only one other thing I have to add is that I would tell my nurses as I begin insertion, aim for the ear (on nostril insertion side). Sometimes that helps get around the bend. Take every opportunity to practice and it will soon become a piece of cake for you.

NocturneRN · Jul 27, 2010

I am a recent grad, new RN. I have only had one order to insert an NG tube so far and the veteran nurse who helped me was not successful in getting the tube in, and when I watched her try to help another new nurse (helping as in doing it) a few days later, she was again unsuccessful. This nurse did not use the technique that we were shown in school; prepping the tube by putting it in ice water to add a curve to the end. She did not have the pt try to swallow water while the tube was going down. She did not have the pt keep their head chin to chest either. Watching someone get an NG tube is one of the worst thing I have seen nurses have to do! I want to know how nurses who are able to get them in with the least amount of trauma to the pt do it. It seems like more and more of our pt load are people with bowel surgeries, and SBO and I know I need to figure out a good technique so I can do this properly without hurting my pts anymore than is necessary (why on earth don't they have a numbing throat spray to make it easier to get it in?). Help!

We used to have RT do lidocaine nebs on patients a few minutes before inserting the tube. We don't do it any more, though, due to the possibility of it affecting the patient's gag reflex (not a good thing, when you're having him/her swallow water to get the tube down). Keeping the patient well medicated for pain beforehand helps.

I've never used ice water to stiffen NG tubes. What I do is coil up the tube in my (gloved) hand, to warm and curve it slightly before insertion, while I'm getting supplies ready. It seems to help. Otherwise, I do it the same way you described. One more suggestion: Ask the patient if s/he's ever had an NG tube before, and, if so, which nostril was used. There's often one nostril that accepts the tube more easily than the other.

HopeItWorksDNP · Jul 27, 2010

I always look into the nose first to see which side appears the most open. Don't use ice on the tube but do use KY jelly to lubricate well. Chin to chest and have pt suck on ice chips if alert. To easy to aspirate if drinking water during procedure. And don't hesitate. If you act like you're nervous about putting it in, its going to make it that much more traumatic for the patient. Never fun.

FockerRN · Jul 27, 2010

If an NG is one of the worst things you've seen nurses have to do then you have seen too little to this point. A couple weeks ago I was up to my wrist in a woman's hip packing a wound and just the other day I helped pack a guy's scrotum and perineum. Anyway, if you ever get to bridle a small bore feeding tube, that is much worse as it involves both nostrils and a string behind the septum.

Small bore feeding tubes I will ice because they are pretty floppy but NG "salem sump" tubes are so dang thick they don't need the ice. I generally put chin to chest (mostly unconscious/semi-conscious patients) and use generous amounts of water soluble lube (anything I put in the nose gets this-dht,ng or bridle). If they can swallow that is great but my pt"s generally can't or won't. On an intubated pt an orally inserted gastric tube is a cinch to place btw.

SoundofMusic · Jul 28, 2010

I've just always sat them up, have them tuck their chin to chest, lubricate it, and start sliding it down, pointing it in towards the opposite nostril. I have them swallow -- for most folks, it goes right down. Always check in the back of the throat tomake sure your'e just not curling it up in the mouth.

And NEVER start the tube feeding until you've gotten confirmation via KUB that it's been inserted into the gastric fundus, or whatever part of the stomach -- or whatever your agency's protocol happens to be. They can mistakenly be put down the trachea, into a lung. I've seen pictures of that.