Please make sure to listen to her when she says do not push past extreme resistance - There have been instances of the NG tube going through the cribriform plate and into the patient's brain. There are also instances of the NG tube going into the patient's lungs. Always get XR afterwards to confirm placement as she says!
This is great information! Always check placement with an X-RAY, at my old hospital a patient died because it was in the lungs. The nurse was fired and an investigation was performed on the unit, doctors, etc. Getting an Xray will protect your patient and your license!
Because when you swallow the water it moves your throat muscles in a way that helps the NG tube go down more easily/efficiently. You can swallow without the water too, but for most people trying to consciously swallow dry with the tube in their throat is going to be even more unnatural and uncomfortable; the water makes the act of swallowing easier.
I'm a RN who has Crohn's Disease, and unfortunately, I need to have NG tubes inserted during my more severe flare-ups. But, after I had a horrible experience with the first NG tube that I allowed a nurse to insert, I quickly determined that it is always best if I insert my own NG tube. I ask for the throat numbing spray, which the ER usually gets from the GI floor, where the EGDs are performed. I ask for the smallest tube I can get my hands on. I only have it inserted for light suction while I'm NPO for bowel rest the first couple of days. I don't get feedings or medications through the tubes. Then I have the tube soaked in warm/mildly hot water for a few minutes, while I get all of the supplies ready to go to make it pliable and as soft as possible (easy to swallow). I get a cup of tepid water to sip during insertion. There are always new nurses who are fascinated with this process when I'm dealing with these tubes for some reason. I even had a doctor say they wanted to see me do the last insertion. I always try to give them tips so that they don't damage the poor people they're working on any more than necessary. Insertion of these tubes can truly cause issues with the pharyngeal area, which is what happened to me the first time. So, I spray the back of my throat just a little to help prevent discomfort. Don't do too much so that the patient can still feel things enough to be able to swallow. I blow my nose. I measure the tube for the length that I'll need to secure the tube at at the opening of the chosen nare. Keep in mind where the suction canister will be to help determine the nare you'll insert the tube into. It's not comfortable to have that tube reaching over you. I dip the warm tip lightly in room temperature water soluble lubricant, take a deep breath, grab my water, and begin to insert the tube. I usually angle my chin towards my chest, but don't put in too close. As I feel it getting to the back of my throat, I begin to take little sips of water and swallow while I push the tube gently down, going with the flow. If the tube hits something, be prepared to pull back a little (this has never happened to me) in order to go at it again. I usually swallow the tube quickly. Once I see that it's down past the esophageal sphincter, I gently push it down until I meet the marked measurement with the tip of my nose. Then, I secure the tube to the tip of my nose (that was already prepped with the alcohol or prep pad) and then to the shoulder of my gown. It's then hooked up to the suction. The whole process only takes a few minutes, and the nurses are always sitting there in awe watching me do this. The most important thing for me is to be sure they know the tips and tricks in order to help others who aren't able to do all of this for themselves. Having a bleeding throat while you have to constantly swallow past a tube is no fun for these people. Be careful with blood thinners if they begin to bleed from this area too! During one of my stays, I refused the Lovenox injection they wanted to give me bc I am usually pretty mobile and do most things for myself whenever possible (I've been told that I'm the best patient EVER!). But after I got into it with one very pushy RN about my refusal of this medication, I had a large bleed from the area in my throat that was rubbing on the tubing during that stay! I woke up to hundreds of milliliters of blood in the canister! So, if I hadn't listened to my own judgement, I may not have awakened. Please, be careful with these people when they are unable to help themselves. And just listen to your patients, especially when they're educated on these things or have been going through their issues for quite a while. To remove the tube, I always am sure to drink a whole cup of water. Then, I suction a good part of the water into the tubing and canister. If you don't do this, the gastric contents, which includes acid, can and often does get all into the pharynx and nose when it's being pulled out through them. That sucks so much! It hurts! Then, get them some tissue so that they can blow their noses. So, that's the tips of the trade to help your patients to the best of your ability, especially if they're alert.
Thank You so much for sharing. I am an RN of 20 years and just getting back into med surg after working L and D. I have always hated putting in an NG tube as I feel for my patients. I will definitely practice using your tips and don’t know why your procedure isn’t standard gold policy.
I had an NG tube put in during my hospital stay in April of last year and absolutely hated it. The feeling of the tube against the throat when you swallow is just awful.
I'm a RN who has Crohn's Disease, and unfortunately, I need to have NG tubes inserted during my more severe flare-ups. But, after I had a horrible experience with the first NG tube that I allowed a nurse to insert, I quickly determined that it is always best if I insert my own NG tube. I ask for the throat numbing spray, which the ER usually gets from the GI floor, where the EGDs are performed. I ask for the smallest tube I can get my hands on. I only have it inserted for light suction while I'm NPO for bowel rest the first couple of days. I don't get feedings or medications through the tubes. Then I have the tube soaked in warm/mildly hot water for a few minutes, while I get all of the supplies ready to go to make it pliable and as soft as possible (easy to swallow). I get a cup of tepid water to sip during insertion. There are always new nurses who are fascinated with this process when I'm dealing with these tubes for some reason. I even had a doctor say they wanted to see me do the last insertion. I always try to give them tips so that they don't damage the poor people they're working on any more than necessary. Insertion of these tubes can truly cause issues with the pharyngeal area, which is what happened to me the first time. So, I spray the back of my throat just a little to help prevent discomfort. Don't do too much so that the patient can still feel things enough to be able to swallow. I blow my nose. I measure the tube for the length that I'll need to secure the tube at at the opening of the chosen nare. Keep in mind where the suction canister will be to help determine the nare you'll insert the tube into. It's not comfortable to have that tube reaching over you. I dip the warm tip lightly in room temperature water soluble lubricant, take a deep breath, grab my water, and begin to insert the tube. I usually angle my chin towards my chest, but don't put in too close. As I feel it getting to the back of my throat, I begin to take little sips of water and swallow while I push the tube gently down, going with the flow. If the tube hits something, be prepared to pull back a little (this has never happened to me) in order to go at it again. I usually swallow the tube quickly. Once I see that it's down past the esophageal sphincter, I gently push it down until I meet the marked measurement with the tip of my nose. Then, I secure the tube to the tip of my nose (that was already prepped with the alcohol or prep pad) and then to the shoulder of my gown. It's then hooked up to the suction. The whole process only takes a few minutes, and the nurses are always sitting there in awe watching me do this. The most important thing for me is to be sure they know the tips and tricks in order to help others who aren't able to do all of this for themselves. Having a bleeding throat while you have to constantly swallow past a tube is no fun for these people. Be careful with blood thinners if they begin to bleed from this area too! During one of my stays, I refused the Lovenox injection they wanted to give me bc I am usually pretty mobile and do most things for myself whenever possible (I've been told that I'm the best patient EVER!). But after I got into it with one very pushy RN about my refusal of this medication, I had a large bleed from the area in my throat that was rubbing on the tubing during that stay! I woke up to hundreds of milliliters of blood in the canister! So, if I hadn't listened to my own judgement, I may not have awakened. Please, be careful with these people when they are unable to help themselves. And just listen to your patients, especially when they're educated on these things or have been going through their issues for quite a while. To remove the tube, I always am sure to drink a whole cup of water. Then, I suction a good part of the water into the tubing and canister. If you don't do this, the gastric contents, which includes acid, can and often does get all into the pharynx and nose when it's being pulled out through them. That sucks so much! It hurts! Then, get them some tissue so that they can blow their noses. So, that's the tips of the trade to help your patients to the best of your ability, especially if they're alert.
You're so right. I had my very first surgery ever 10 weeks ago. I had general anesthesia and found myself intubated with a ng tube and a catherine when I awakened. I had that miserable tube in for 4 days as well as the catheter. I never had a chance to refuse them and that hospital stay was the worst 5 days of my entire life. No more surgeries, no more hospitals ever again. ☹️☹️😡😡
I am in my second year. Thanks for sharing, I have been watching my practice assessor doing it but there have been no much explanation on it, now I can repeat and repeat different videos. I am very greatful for your videos, thanks for sharing. I think I have a better knowledge about the NGT,
@@LevelUpRN Yes it was and it is still helpful cause when I am at home I go on You Tube and watch the video again and again. I shall watch it till I can do it myself to demonstrate to a patient whilst on assessment with my assessor.
Thank you so much for sharing your expertise. I was just hospitalized for a bowel obstruction. I had absolutely NO IDEA anything was wrong until I started experiencing intense pain/cramping. I KNOW that sounds crazy to a professional. I thought the pain would pass. It’s happened before but luckily I was at my fathers house this time and he called 911. Long story short, the nurses and CNA’s who treated me were excellent. I have always respected healthcare professionals, you all are AMAZING.
Hello the nurse is caring for a client receiving enteral nutrition through a nasogastric tube. before initiating the next bolus fee, the nurse checks residual and notes 250 ml of bright green fluid. Which actions by the nurse are appropriate? Select all that apply a) Auscultate for bowel sounds b) document the residual c) do not administer the tube feeding d) discard the residual Is it AB or ABC?
Are you referring to when we withdraw some to test for pH? Because, I've always wasted that as it's such a small amount. When we check for gastric residual related to enteral feeding, we generally return the contents. - Ellis
HI WE COULDN'T DENY THE ACTIVE ROLE DISPLAYED BY NURSES IN INSTANCE A PROF SPECIALIST ENT MAY FAIL IN INSERTION A RYLE TUBE AT THE ICU SOME NURSERY TEAM COULD PERFECTLY INTRODUCE IT
I am a first year, first semester nursing student and I have to say that your videos are truly saving my life. So many helpful tips and tricks. I love your content! Thank you!🥰🥰
There's really no side that's preferred over the other. Always inspect the patient, though! They may have a polyp obstructing one side which would require you to use the other.
Nope! This is a clean skill but does not require sterile technique because the GI tract is not sterile. I like to remind my students that we eat and drink things all day and none of that is sterile! - Ellis
Generally, clinical skill steps would be the same for a pediatric patient. You would, of course, use smaller equipment and a depending on their age you'd need to use different communication methods.
The smallest one possible and needed for what you are having it inserted for. I have them for bowel rest, with no meds or food being administered through them. So, I try to get the smallest tube the hospital has over the ones used for small children.
