NG Tubes Suck: Gastric Contents from Patients and the Life out of me!

On the NG tube issue, I have already written about about a recent NG tube order fiasco, which caused me considerably more grief than it ever should have.  A patient who gets to the floor at 6:40 am, with a doctor in the room at 6:50 giving verbal orders, requires an NG tube. So I gather supplies, assistance, and went on in to shove that sucker down. I verified placement with air, and it started to produced some drainage. Then the devil himself decides to get involved, possesses this man, and even with the tube in place, exorcists style projectile vomiting takes place right when our most talented and accomplished surgeon walks in the room. When I ask for help from oncoming nurses, saying I need immediate assistance, basins, gowns, etcetera, they just sit there. I have to say it again, loudly and nearly demanding. I have 2 doctors in the room, a P.A. student, the wife, and the patient, and I’m pretty certain Satan himself had joined the party — and they just stare at me!

I went back in the room, and attempted to do my very best with what I had there, the PA student even went out and got the basin. Finally the receiving nurse moseys in the room and says “Do you need me to bring you something?”. Um NOOOO! Its 7:20, and this is your patient! “He needs some nausea and pain medicine. If its not into computer yet, you need to call pharmacy.  He needs it now.” 

Of course now is the point where the talented surgeon lets me know, respectfully, I might add, that the tube needs to be advanced about 2 inches. He, and the oncoming nurse assisted, we pushed it down, and finally the sucker started flowing like Niagara Falls.

I was so glad to get it working, cleaned the patient up, and handed off remaining tasks to the oncoming nurse. I walked out of the patients room and finished up my charting was preparing to go home.

Of course the radiant beams of sunshine that are the most talented nurses of all time are all  sitting around discussing how things should have been handled, what they would have done, and how they would just be mortified to have that happen in front of that particular surgeon.

So I did what I do. I took the awkward moment of potential embarrassment and I used it as an opportunity to learn.

Why didn’t the NG work the first time? I had followed the same method taught me in school, by the other nurses, and what had worked well in the past, and there was some drainage coming out, but it wasn’t in place appropriately. Why?

I strolled up to the physician, who at this point was nearly done with his rounds and was documenting in progress notes. “Can you please tell me what I did wrong?”

A beaming smile came upon his face, and he, who is very tall, and always appears so confident, placed his large hand on my shoulder and said “Nothing at all… everyone’s anatomy is different, I’ve just been inside enough people to know. Here let me show you.”

He took a blank progress note from the chart and began drawing a rudimentary GI tract. He showed me the appropriate destination for the tip of the tube and discussed lines on the actual tubing, which we were always told to ignore in school. He used terms like “paydirt” and made use of his hands for emphasis in the conversation. It was probably some of the best education I have ever received. And in the end he thanked me for taking the time to clarify the procedure but reassured me that he knew I did my best for the patient.

Of course the bullies found great humor in the whole incident. But I found a learning opportunity and affirmation that I did the right thing.

To heck with the bullies. And to heck with NG tubes… I HATE those things!