Vitals, Transfers and NG tubes, OH MY!
Today we learned about NG (Naso Gastric) tube feedings. This was pretty cool but also as with everything there are a TON of steps to remember. Wanna go through them all? Ok:P When you first walk into the room you want to make sure you have the right patient. Match the name AND the number on the ID bracelet with the name AND number in the chart. Go ahead and close the curtain as you will be partially exposing the patient during the procedure and you want to maintain privacy. Ok, now let's raise the bed up to a comfortable working height, we don't want to strain our backs now do we? You have of course gathered all of your equipment before arriving to the patients room. You have set up on the table your syringe, your feed, gloves, a cup and your chart. Before we go ahead and begin feeding we want to make sure the tube is still in place. You never know if the patient accidentally moved it during the night or what not. So first, grab your syringe and fill it with 20 ccs of air. Now take the NG tube and kink it TOWARDS the patient. If you kink it away from the patient you might dislodge it and BOY will you feel like an idiot when they cry in pain and or vomit or choke. Yeah...Ok so kinking the tube towards the patient go ahead and take out the stopper and insert the end of the syringe. You can go ahead and unkink the tube now. Go ahead and lay the tube down on a paper towel that you had previously positioned near the patient so that you aren't tugging on the tube while working. Now put your stethescope in your ears and lift the patient's gown to expose the chest. You want to palpate the xyphoid process and one inch below that should be the stomach. Go ahead and place your stethescope there. With the other hand grab the syringe still attached to the NG tube and quickly push the 20 ccs of air into the tube. If the tube is positioned correctly you should hear a pop or some type of noise when the air hits the stomach. If you heard it great! If you didn't try again. If you still didn't hear it, try having the patient lay on their side and do it again. If you still didn't hear it, the tube has moved and you go get help.
Let's assume you heard the noise you were supposed to hear. Great. Now we need to check for residule. Nice and slowly pull back on the syringe and see if you can remove any stomach contents. Keep pulling back until you can't anymore. If the amount of residual is less than the alloted amount in the chart then great, go ahead and slowly push the contents back into the tube. If the contents filled up the tube and there is still more, well then you need to kink your tube TOWARDS the patient, remove your syringe, recap the tube, put the tube down gently on your paper towel, empty the contents into a cup you previously got ready just in case, go back to the tube, kink it TOWARDS the patient, uncap it, replace the syringe and continue removing residual until it is done. If it's still less than the prescribed amount go ahead and slowly push it back into the tube. Kink and recap it, lay it down on your paper towel, fill the syringe up with the contents you put into the cup, rekink the tube, uncap it, replace the syringe and slowly push all the contents back into the stomach. Ok, there! NOW you are ready to feed the patient, bet you forgot that's why we came here:P
Now, check your feed. Make sure it matches the orders in the chart, make sure it isn't expired and that you have enough. Now, pull down the feed bag. Make sure the line from the bag is closed or you will have NG feed dripping ALL over the floor...won't you feel stupid:P (It's gonna happen to everyone once they say) Ok now pour the prescribed amount into the bag. Get the air bubbles out and close the bag. IF you are doing a bolus or intermittent feed you want to open the line, squeeze the outpouching in the bag ONCE and wait till it is half full. Close the line. Now get your empty feed can or a cup and place the end of the line in the cup. Reopen the line and prime the line with the feed until it reaches the end of the line. Reclose the line. If you were doing a continual feed then after you poured the feed in and got the air bubbles out, you would open the line and hold it side ways while the outpouching in the line filled half way up. Then you would close it, turn the line vertical, reopen it, and prime it as before. Ok either way, we're done with that step. Now go back to the patient, kink the NG tube TOWARDS the patient, uncap it and insert the line (which you remembered to uncap at some previous step) into the NG tube. Unkink and reopen the line. I left out steps, like what to do with the caps while you cap and uncap and what not. Also for a continual feed you need to run the line through a machine, but our group didn't get to practice with a machine today so that just means I get to be surprised by one in the field. Lucky me.
Ok, so you hung out in the room for a bit to make sure everything was working and now you lower the bed to it's lowest position, leave the call button near the patient in case they need it and you go about your other business. When the feed is done you return to the room. Now you need to irrigate the line with whatever amount of water the doctor prescribed. So, lets get that bed back up to a comfortable level, now lets fill up a syringe with the prescribed amount of water. Kink the tube TOWARDS the patient. Remove the empty feed line, closing it just in case and place the syringe in the tube. Now slowly push the water into the tube. All good? No vomiting? Terrific! Kink the tube TOWARDS the patient, remove the syringe and replace the cap. Lower the bed to it's lowest level. Wish Mr. Jones or whatever a good day and off you go.
It's tough, I mean, it's not tough as in difficult but just so many steps and one mistake can cost you BIG! I hope I don't make a jack ass of myself on the floor when true clinicals start. It would help if my teacher wasn't the devil. It would also help if ALL our teachers gave us the same info. Today during transfers I was holding the patient by the shoulders and one of the teachers told me to support their head. Ok, sure that makes sense. Five minutes later Nazi teacher comes by and RIPS into me about why am I holding the head, you NEVER put your hand on the back of someones head and blah blah blah. Sigh, smile and nod and thank her for informing you. Shrug it off. Grrr. Oh well, like I said, she yells at everyone.
So week two is done. Nine weeks left to go (not counting finals week) Man I can't believe I only have nine more weeks to get everything down packed. It seems insane. Breathe...and get back to studying!!!
Let's assume you heard the noise you were supposed to hear. Great. Now we need to check for residule. Nice and slowly pull back on the syringe and see if you can remove any stomach contents. Keep pulling back until you can't anymore. If the amount of residual is less than the alloted amount in the chart then great, go ahead and slowly push the contents back into the tube. If the contents filled up the tube and there is still more, well then you need to kink your tube TOWARDS the patient, remove your syringe, recap the tube, put the tube down gently on your paper towel, empty the contents into a cup you previously got ready just in case, go back to the tube, kink it TOWARDS the patient, uncap it, replace the syringe and continue removing residual until it is done. If it's still less than the prescribed amount go ahead and slowly push it back into the tube. Kink and recap it, lay it down on your paper towel, fill the syringe up with the contents you put into the cup, rekink the tube, uncap it, replace the syringe and slowly push all the contents back into the stomach. Ok, there! NOW you are ready to feed the patient, bet you forgot that's why we came here:P
Now, check your feed. Make sure it matches the orders in the chart, make sure it isn't expired and that you have enough. Now, pull down the feed bag. Make sure the line from the bag is closed or you will have NG feed dripping ALL over the floor...won't you feel stupid:P (It's gonna happen to everyone once they say) Ok now pour the prescribed amount into the bag. Get the air bubbles out and close the bag. IF you are doing a bolus or intermittent feed you want to open the line, squeeze the outpouching in the bag ONCE and wait till it is half full. Close the line. Now get your empty feed can or a cup and place the end of the line in the cup. Reopen the line and prime the line with the feed until it reaches the end of the line. Reclose the line. If you were doing a continual feed then after you poured the feed in and got the air bubbles out, you would open the line and hold it side ways while the outpouching in the line filled half way up. Then you would close it, turn the line vertical, reopen it, and prime it as before. Ok either way, we're done with that step. Now go back to the patient, kink the NG tube TOWARDS the patient, uncap it and insert the line (which you remembered to uncap at some previous step) into the NG tube. Unkink and reopen the line. I left out steps, like what to do with the caps while you cap and uncap and what not. Also for a continual feed you need to run the line through a machine, but our group didn't get to practice with a machine today so that just means I get to be surprised by one in the field. Lucky me.
Ok, so you hung out in the room for a bit to make sure everything was working and now you lower the bed to it's lowest position, leave the call button near the patient in case they need it and you go about your other business. When the feed is done you return to the room. Now you need to irrigate the line with whatever amount of water the doctor prescribed. So, lets get that bed back up to a comfortable level, now lets fill up a syringe with the prescribed amount of water. Kink the tube TOWARDS the patient. Remove the empty feed line, closing it just in case and place the syringe in the tube. Now slowly push the water into the tube. All good? No vomiting? Terrific! Kink the tube TOWARDS the patient, remove the syringe and replace the cap. Lower the bed to it's lowest level. Wish Mr. Jones or whatever a good day and off you go.
It's tough, I mean, it's not tough as in difficult but just so many steps and one mistake can cost you BIG! I hope I don't make a jack ass of myself on the floor when true clinicals start. It would help if my teacher wasn't the devil. It would also help if ALL our teachers gave us the same info. Today during transfers I was holding the patient by the shoulders and one of the teachers told me to support their head. Ok, sure that makes sense. Five minutes later Nazi teacher comes by and RIPS into me about why am I holding the head, you NEVER put your hand on the back of someones head and blah blah blah. Sigh, smile and nod and thank her for informing you. Shrug it off. Grrr. Oh well, like I said, she yells at everyone.
So week two is done. Nine weeks left to go (not counting finals week) Man I can't believe I only have nine more weeks to get everything down packed. It seems insane. Breathe...and get back to studying!!!