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Tricks for putting down NG tubes?

Posted

Last night I had to put down a Dobhoff-weighted NG tube on a patient with moderate dysphagia and confusion who had pulled out his previous NG tube. I have only done this 2 previous times and this was my first night on my own, just got off of a 12-week orientation. The other nurses were happy to help and I finally got it down after 4 tries-at least I thought so anyway. The xray revealed it was curled up in his throat. Any secrets or special tricks anyone have for getting these in the right place? I had him sitting up, another nurse was helping him to tuck his chin, we tried to have him drink, I even put the tube in some ice to firm it up. Any suggestions for this new nurse?:nurse:

The drink and the ice were my two suggestions...since you already did that there probably wasn't much more you could do. Every once in a while you just get a difficult patient and it takes a couple of tries.

TexasPediRN

Specializes in Pediatrics Only.

I hate DHT's...

I find someone who likes to put them in to do mine!!

Thats my trick :devil:

suanna

Specializes in Post Anesthesia. Has 30 years experience.

ICE ICE ICE the tube. If you can get the tube cold enough to hold shape when bent- curve the tip 45 degrees and insert it into the most open nostril with the curve arching downward. Once you are in the pharnyx rotate the tube 90 degrees to position the tip toward the back of the throat. Watch the patient for swallowing. As they swallow advance very quickly, after swallowing advance more slowly. Most insertions will become more difficult the longer you are in the throat-the tube becomes soft and coils, the patients' gag reflex is more and more irritated, so the faster the advance the better even if a patient dosn't swallow at all.

crb613, BSN, RN

Specializes in Med Surg/Tele/ER. Has 7 years experience.

I hate DHT's...

I find someone who likes to put them in to do mine!!

Thats my trick :devil:

:lol2::lol2: You would be looking for me....I'll do NG's all day I just don't want to put an IV in a baby :nono:. I just curl mine several times around my finger. Look for the most open nostril....lube it up really good...curve down, aim toward the ear on my way down, sometime rotating a bit....have them swallow (water), when they gag.....then advance, advance, advance. I also pt my hand behind their head to kinda help keep chin to chest.

RN1982

Specializes in ICU/Critical Care.

Sometimes I spray a little cetacaine in the back of the throat. Helps it be a little less painful. I've also seen nurses put the NGT in icewater before inserting it.

S.T.A.C.E.Y, LPN

Specializes in Emergency. Has 2 years experience.

I know some nurses who put the NG tube in the freezer, to keep them stiff. And one doc who tells us to use xylocaine jelly in the nare a few minutes before we insert the tube, to make it less traumatic for the patient.

I'm just a nursing student, but when we were taught how to do NG tubes we were taught to never use ice or cold water on an NG tube because it stiffens the tube and can cause trauma to the patients membranes. Now, I'm sure things are different in the real world of nursing, but just curious if this was a trick you were taught in school or what because we were told we can never do that.

We were basically taught to lube up the tube, angle it back towards the ears twirling the tube helping to ease the insertion, then when the client gags have them go chin to chest and swallow water and push the tube down further while they swallow.

babynurselsa, RN

Specializes in ER, NICU, NSY and some other stuff. Has 12 years experience.

We get an order for lidocaine 2% neb tx. Makes it comfortable for the patient. This makes it easier to pass because the patient is not reflexively fighting the tube going down.

I know some nurses who put the NG tube in the freezer, to keep them stiff. And one doc who tells us to use xylocaine jelly in the nare a few minutes before we insert the tube, to make it less traumatic for the patient.

i have frozen my ng tubes for yrs.

right before placing, i curve the end at approx 20-30 angle.

never coils.

leslie

XB9S, BSN, MSN, EdD, RN, APN

Specializes in Advanced Practice, surgery. Has 33 years experience.

I love placing NG tubes, I never miss although now I've gone and jinxed myself

I do all of the above, sit up, chin on chest, clear instructions, get them to drink and if possible with a straw as I find it helps. Get them to concentrate on swallowing and push the tube when they are swallowing.

It is always more difficult with confused patients as they don't always understand the instructions.

RN1982

Specializes in ICU/Critical Care.

I love placing NG tubes, I never miss although now I've gone and jinxed myself

I do all of the above, sit up, chin on chest, clear instructions, get them to drink and if possible with a straw as I find it helps. Get them to concentrate on swallowing and push the tube when they are swallowing.

It is always more difficult with confused patients as they don't always understand the instructions.

I missed once. I put it in one nare and it came out the other.

XB9S, BSN, MSN, EdD, RN, APN

Specializes in Advanced Practice, surgery. Has 33 years experience.

I missed once. I put it in one nare and it came out the other.

:uhoh3: :uhoh3: I bet that brought a few tears to your patients eyes. At least you didn't have to go looking for where it had coiled :D

Sometimes I spray a little cetacaine in the back of the throat. Helps it be a little less painful. I've also seen nurses put the NGT in icewater before inserting it.

I thought Cetacaine was only to be used for intubation as it numbs them to the point of not having a gag reflex. Do they have a milder Cetacaine out there now? I don't know where I work they have a special dept for each and every little thing including a dept that puts down ND tbes

Indy, LPN, LVN

Specializes in ICU, telemetry, LTAC. Has 5 years experience.

I've never heard of freezing a dobhoff. I'm definitely gonna try that. I think the thing in NS about not icing them was talking about regular ole salem sump tubes, which are usually already stiff enough to go down. Dobhoffs are little and flimsy even with the stylet in them.

How do you folks feel about the stylet by the way. Leave in for the Xray or take out? I like to take them out prior to Xray if the tip is metal weighted, so that if it's gonna come back up I'll know it on the film, instead of having a good film then lungs full of tube feeding later, which I've seen happen.

10MG-IV

Specializes in TraumaER ,NICUx2days, HEMEONC CathLab IV.

Well, here is one for you. I warm the Salem sump tube! Curl it in a styro cup of very warm water. It becomes very flexible and easy to navigate the curves. Have the Pt sit straight up chin on chest with a cup of ice / water in a cup with a straw handy. Have your tape torn and the bulb syringe already attached to the end of the tube. Have your suction ready and a towel or sheet over the pts lap. Reassure the patient, Lube that puppy up with viscous lidocaine and slowly gently slide it in. Stop if you meet resistance. Don't keep on shoving, wait for the "swallow" and coordinate the insertion with the "swallow"

I found if the tube is flexible, it manuvers on down. Coach them on swallowing and check the back of the mouth throat for curling. I have had great luck with this method a "old nurse" showed me. Let me know if this works for you!:coollook:

Edited by 10MG-IV
added word.

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