Tricks for putting down NG tubes?

[Dancin'Mom]

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?

[XB9S, BSN, MSN, EdD, RN, APN]

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

: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

[Miami NightNurse]

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]

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]

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!