NG insertion while holding breath for maximum success & minimum pain!
Why and how!?! Short thread!
The why: in my experience, it makes the pt much more comfortable by making them a bigger part of the experience (by working with you), WITHOUT the stress of having to gulp 1/
Why and how!?! Short thread!
The why: in my experience, it makes the pt much more comfortable by making them a bigger part of the experience (by working with you), WITHOUT the stress of having to gulp 1/
2/ water down - 2 things: 1) NGs are often for those vomiting/nauseous - the LAST thing they want to (or can) do is guzzle, sip, or imbibe water. Horrific. 2) it removes the stress of 'now it's at the back of your throat, you feel like retching - QUICK, drink water!' In my 3/
3/ experience, this is often when they tear up and feel WORST - trying valiantly to down water while choking on a big-arse hose choking them.
Without the stress of having to swallow water, you can work 'with' them in a WAY more gentle & relaxed fashion, which in turn makes /
Without the stress of having to swallow water, you can work 'with' them in a WAY more gentle & relaxed fashion, which in turn makes /
4/ insertion much easier - far less struggling, gagging, spasming, etc.
This has been explored in a couple of journal articles but briefly:
- holding the breath closes the epiglottis & glottis, decreasing or removing the chance of the tube entering the trachea.
- So how /
This has been explored in a couple of journal articles but briefly:
- holding the breath closes the epiglottis & glottis, decreasing or removing the chance of the tube entering the trachea.
- So how /
5/ do I go about it?
1. I explain where the tub needs to go, highlighting 2 main points:
- the discomfort as it travels along the nostril
- the EXTRA discomfort when it hits the back of the nasopharynx, at which point we'll stop, they'll take a deep breath & hold, /
1. I explain where the tub needs to go, highlighting 2 main points:
- the discomfort as it travels along the nostril
- the EXTRA discomfort when it hits the back of the nasopharynx, at which point we'll stop, they'll take a deep breath & hold, /
6/ - and I'll slip it down their throat. It'll go in EASY because they're not fighting to down water at the same time; they have NOTHING to do except hold their breath tightly. My 3rd highlight to them is,
- 'If you need to breathe, you squeeze my hand/arm, and we'll stop, /
- 'If you need to breathe, you squeeze my hand/arm, and we'll stop, /
7/ 'you'll take a few breaths, catch you breath, then when YOU'RE ready, you hold again and we'll get it in the rest of the way - once it's past that first bit, that's the worst and we're almost home.'
- I explain that it's SUPER uncomfortable, but quick, but that they're in /
- I explain that it's SUPER uncomfortable, but quick, but that they're in /
8/ control - I'll be watching their breathing, & if we have to stop, we stop.
Breath holding ensure that if they're really struggling or we need another go (down another nostril, or a different sized tube), they don't have to drink MORE water. While choking.
Generally, /
Breath holding ensure that if they're really struggling or we need another go (down another nostril, or a different sized tube), they don't have to drink MORE water. While choking.
Generally, /
9/ how it goes is this: I lube up the tube, sit it really gently in the nare, & we talk-breathe together a few times - 'ok, it's just sitting here. Big slow breaths. Excellent. Good. Ok, keep going.' They breath, and then there's the catch when it hits the back of the phar. /
10/ Then (holding the tube firmly so it doesn't slip, but doesn't get more uncomfortable) I say 'Fantastic. Now, we're at the breath holding bit. Take a few breaths, then when you're ready, big breath in and hold. Grip tightly.' They feel so much more in control (bc they are), /
11/ it's very obvious when they take the big breath. At that point, with nice neck posture & the lack of struggle (bc they're not fighting w/ the H20), I can USUALLY get it all the way down (that is, at least 20 cm in). If not (but it's further in), they'll signal, I'll hold so /
12/ it doesn't slip out, & we repeat - - they take a few breaths to relax, I encourage then when they're ready, big breath hold, & the rest of the way in.
After that, easy as! Once it's IN, (as we've all seen) it's uncomfortable & gross, but I see far less gag reflex, so if /
After that, easy as! Once it's IN, (as we've all seen) it's uncomfortable & gross, but I see far less gag reflex, so if /
13/ I need to slip it in farther (depending on if I'm getting aspirate yet), it's not so bad & they can breath through it.
Since starting this, I haven't had an NG fail me yet, & have been able to get NGs in its where we've had failures w/ the water method, bc we can talk /
Since starting this, I haven't had an NG fail me yet, & have been able to get NGs in its where we've had failures w/ the water method, bc we can talk /
14/ through the pain & panic, & I can assure them that this method can, if they want to, be slower & less frenetic, bc we're not trying to shove it down during the time it takes them to (hopefully) down a glass of water, & no more.
I LOooOOoOoOVe it, & I hope it works well for
I LOooOOoOoOVe it, & I hope it works well for
15/ you all too! Let me know how you go, please, & what helps you!
#NGTubes #ngTubes #nasogastric #medTwitter #NurseTwitter #procedures #nasogastricTube #MedEd #AlwaysImproving! :)
#NGTubes #ngTubes #nasogastric #medTwitter #NurseTwitter #procedures #nasogastricTube #MedEd #AlwaysImproving! :)
16/ edit: guys, who are we kidding. I can't do short threads. I'm sorry, I'm just so excited.
But NEway, here's an excellent Medscape article on NG insertion which also mentions the how/why of breath-holding technique. emedicine.medscape.com/article/80925-…
But NEway, here's an excellent Medscape article on NG insertion which also mentions the how/why of breath-holding technique. emedicine.medscape.com/article/80925-…
