Why would you place a OGT and give zofran in the middle of a surgery?

SuperSleeper · Jan 9, 2009

Yes. It could be indicated in a non-abdominal surgery. There is always the possibility of air in the stomach with manual ventilation. Or, if the tube was dropped down the esophagus by accident at the beginning and the pt was re-intubated. Stomach decompression may be done in an attempt to decrease intra-abdominal pressure to aid in venous return. Or....the pt may have a history of significant post-op nausea and vomiting. Or....the pt may have regurged some stomach contents at intubation and the provider wanted to prevent that from happening again at extubation. There are a number of reasons to do this. My list is not exhaustive.

Hope that helps some.

SS

Keysnurse2008 · Jan 10, 2009

yes. it could be indicated in a non-abdominal surgery. there is always the possibility of air in the stomach with manual ventilation. or, if the tube was dropped down the esophagus by accident at the beginning and the pt was re-intubated. stomach decompression may be done in an attempt to decrease intra-abdominal pressure to aid in venous return. or....the pt may have a history of significant post-op nausea and vomiting. or....the pt may have regurged some stomach contents at intubation and the provider wanted to prevent that from happening again at extubation. there are a number of reasons to do this. my list is not exhaustive.
hope that helps some.
ss

actually this helps alot. the patients surgery was something like a knee replacement ( i will not list the exact surgery or the sex of the pt ),...but it was something similar. the patient had a h/o ponv and had aspirated once i believe in the past. but after surgery placed on a mso4 pca and was immediately ordered a regular diet ( mystery meat and gravy served and eaten 3 hours post op) and then began vomiting uncontrollably for hours till they aspirated and got very sick requiring reintubation .they stayed in our icu for about 6 weeks. i will leave it at ...it was a bad outcome. so...another question.....what is the best way to avoid post op aspiration in these high aspiration risk patients?

SuperSleeper · Jan 10, 2009

Well, as I'm sure you're well aware, there are no guarantees. However there are things that may decrease the risk. Like: strict NPO prior, triple treat (reglan, pepcid, bicitra) before surgery per pt condition, NGT intraoperatively, zofran given intraop, cricoid pressure at intubation, making sure the pt is optimized before surgery, not giving food/drink to a person with questionable airway reflexes postop (my favorite - you'd think it would be a no-brainer, but...), etc...

ss

Keysnurse2008 · Jan 10, 2009

well, as i'm sure you're well aware, there are no guarantees. however there are things that may decrease the risk. like: strict npo prior, triple treat (reglan, pepcid, bicitra) before surgery per pt condition, ngt intraoperatively, zofran given intraop, cricoid pressure at intubation, making sure the pt is optimized before surgery, not giving food/drink to a person with questionable airway reflexes postop (my favorite - you'd think it would be a no-brainer, but...), etc...

ss

amen brother! that is what i said! i think it was a medical student that wrote the regular diet order on a pt with a h/o aspiration, ponv ....and then start then on a opiod pca too. this is what i really didnt understand too. i cant imagine he bothered with reading the h&p prior to writing that order.

skipaway · Jan 12, 2009

amen brother! that is what i said! i think it was a medical student that wrote the regular diet order on a pt with a h/o aspiration, ponv ....and then start then on a opiod pca too. this is what i really didnt understand too. i cant imagine he bothered with reading the h&p prior to writing that order.

when i was a floor nurse, prior to becomming a crna, we did not take orders from med students. has that changed? i may have questioned the regular diet order, to the patient's resident, if the pt. had a known history of aspiration.

celclt · Jan 12, 2009

I can see it to keep them as comfortable coming out as they went in....

Keysnurse2008 · Jan 12, 2009

the order was signed off by the cheif resident. btw - pt had a neuro injury about 12 years prior to surgery and ...and had a limited gag reflex . so i really am perplexed as to why they ordered a regular diet . the mr was full of information about the neuro insult years ago ...bc we treated the pt for it! so now we are having to explain to risk management why we fed a high risk aspiration patient less than 4 hours post op a regular diet ( mystery meat gravy and potatoes etc ) and then placed them on a diluadid /morphine pca. then they ended up - suprise suprise with uncontrolled vomiting for hours on end (over 8 hours)till they finally aspirated.

NICU_RN_CN · Jan 22, 2009

I give all my patients Zofran in the OR intraop. OGT for big ABD cases and as well as Laparascopic cases. The patient might have gastroparesis secondary to Diabetes. Reglan & pepcid preop would be nice also.

subee, MSN, CRNA · Jan 31, 2009

I believe there is no documentation on the effectiveness of Reglan or the placement of an OG tube ROUTINELY. It is just one of those voodoo practices you learned way back when and never changed.

Sophie2day · Jan 31, 2009

Just curious why the inital question of this post is regarding the CRNA practice during the case - inserting an OGT and giving Zofran - had to do with the patient being permitted to eat a full meal and aspirating? Sounds like the CRNA did what could be done to prevent this event.

Just because someone wrote the order the patient could eat a full diet - doesn't mean the RN had to start with a full tray - this is where judgement skills come into play - ie clear liquids - jello - crackers - and see how the patient feels.

Keysnurse2008 · Feb 3, 2009

just curious why the inital question of this post is regarding the crna practice during the case - inserting an ogt and giving zofran - had to do with the patient being permitted to eat a full meal and aspirating? sounds like the crna did what could be done to prevent this event.
just because someone wrote the order the patient could eat a full diet - doesn't mean the rn had to start with a full tray - this is where judgement skills come into play - ie clear liquids - jello - crackers - and see how the patient feels.

hi...no problem. i will answer this. my initial question was "why would you place and ogt intra op and give zofran?". i asked ...bc i wanted to know. i did not know if this was common practice or not. my specialty is icu and i am not a crna so i did not know if this was something that commonly was done in every single case no matter what the procedure etc etc etc. i know this pt aspirated and with their hx ...common sense would have said start them on sips first, but that didnt happen. when the case was reviewed actually the cheif anesthesia md questioned whether it was actually aspiration pneumonia or perhaps chemical pneumonitis.....so that is why i was wondering if ogt 's are routinely placed in plain ortho patients. no one is placing blame we just want to make sure an event like this doesnt reoccur...so we are looking at root cause analysis. you could say the floor rn should have had the sense not to feed them despite the order.....or that it was the mds fault bc they knew the pts history and ordered a reg diet....but in the end you just want to make sure it doesnt happen again. when things like that happen we all have a responsibilty to place the safety of the patient first by evaluating their history and thinking before we write orders. :twocents:

codyj · Mar 6, 2009

The other reason an OG may have been placed is if the patient was a difficult intubation, or difficult to mask on induction -- the OG can remove air that may have gone into the abdomen