Do it yourself NG tube insertion...

So the other day probably saw the most ridiculous thing in my nursing career to date... a patient inserted his own NG tube.

For those who don't know what an NG tube is, let me clarify: it's called a nasogastric tube. Basically, it's a tube inserted through one of your nostrils and advanced until it reaches your stomach. Confirmation in the state of Georgia is initially made by two Registered Nurses. A small amount of air (usually 10 cc a.k.a. 10 mL) is drawn into a syringe that's then attached to the end of the tube. The air's injected and you listen for a gurgle. A clear gurgle along with aspiration of gastic contents via the syringe confirms placement of the tube.

Depending on the patient (nasal obstruction, anatomy, mechanical ventilation), the oral route may be preferred and the tube is then called an OG (orogastric) tube.

Well, for conscious patients, putting in an NG tube is painful. First, you're putting something where it doesn't belong. Second, when you get deep into the nose and hit the back of the throat, the patient gags. To assist with passage of the tube to the stomach (and not the lungs), the patient is sometimes given ice to swallow, and instructed to swallow upon initiation of the gag reflex. The patient is also placed in an upright sitting position with the head to the chest. Again, for easier passage of the tube (but probably also for patient safety... if they're sitting up, they're less likely to aspirate or choke on vomit, etc).

Okay... school lesson over. Story time.

We get a patient in right before shift change. He's a suspected GI bleed and the physician wants us to insert an NG tube and lavage his stomach. That's a fancy way of saying he wants us to put in a tube and wash out his belly with water.

Long story short, we're about to do the deed when the patient tells me and another nurse, "Yall step back, I got this."

"Excuse me?" I ask.

"I've got this."

I snort in surprise and disbelief.

"You know what an NG tube is, right?" I ask.

"Yup."

"Okay, have you ever had one in before?"

"I've placde 'em on myself before."

I shake my head at that.

"Man," I exclaim, "if you can actually put that thing down and get it in place... I'll be amazed."

"I got this," he calmly replies.

"Alright man..."

The guy calmly lubes up the tip of the NG tube in KY jelly ( a standard for NG tube insertion) after estimating the length required to reach his belly. He then proceeds to slowly insert it into his noise and advance it past his throat. He gags a few times as he does this, but holds it together. Way better than I would have. Better than most people I could think of.

Sure enough, he gets  to his estimate of where it should be to reach his belly. Me and the other nurse comfirm placement.

"I'm glad I didn't bet you any money," I say.

He laughed.

Never say never.

I paged the physician to tell him about the ridiculous feat I witnessed. He was just as surprised as I was.

Add another to the record book.