Vent and NGT Question

[GatorRN21]

Sometimes a kiddo will return from surgery without a NGt in place and is ventilated. The plan usually is to extubate the kid but when would it become time to put a NGt in a kid that hasn't been extubated yet? Last night I was working, the kid returned from surgery at 2p and wasn't extubated until 11p so should a NGt been placed? Abdomen of the kid was not distended.

[PICNICRN, BSN, RN]

Do you have a VAP protocol in place? Ours states that all tubed kiddos have an OG(not NG) in place. I usually drop one in while they're still zonked even if they are planning to extubate in the am- that way I'm by the book..... we actually have the "VAP police" coming by to check that pt's HOB are at 30 degrees and so forth. Guess they have nothing better to do! I guess it would depend on the situation- like would it have just caused unessessary stimulation and discomfort to place one rather than not?

[Redneckmedic63]

Not just for VAP protocols, but just for aspiration prevention, we always place gastric tubes (NG or OG) on intubated pts., even if short term. No more discomfort than they already have with the ETT, and certainly easier to do while they are still sedated. We will always make sure the belly is empty prior to extubation, and apply suction to the ETT, once deflated, as we pull everything. Even if they have been NPO, there is always the risk of aspiration if those gastric juices, swallowed saliva, etc... are not emptied first. Only exception I can think of are the patients we receive direct from OR - we often recover patients in PICU vs them going to PACU - and they are immediately extubated when they arrive in the unit. Our pediatric anesthesiologist will often accompany the kid to PICU and do it there as soon as the kid arrives. Go with your common sense - better safe than sorry!

[AlabamaBelle]

Any intubated in our unit gets an NG/OG, even if extubation is planned within the next few hours. Always better safe than sorry.

[tryingtohaveitall]

Our old policy was that everyone intubated had an NG/OG the entire time. Once we started doing NDs, we'd usually pull the NG/OG while we were placing the ND as long as they weren't having stomach/bowel issues. Interestingly enough, we realy haven't had a problem with abd distension unless they have an ileus. If your ETT is an appropriate size, you shouldn't be getting a lot of insufflation of air into the belly.

When we're able, we'll place the ND shortly after intubation so we can check placement with only 1 film. We'll decompress the belly of the excess air gained during the intubation, then go ahead and place the ND. We've done it this way for quite a few years now. Being able to feed earlier in the game has been quite helpful.