Pearls for putting in gastric tubes.

[numbmd]

Putting in a gastric tube can be the most annoying thing we do at times. Sure, I could do it as a 3rd year med student, but every once in a while I have a patient that wants to make me look and feel stupid. Especially when the surgeon is waiting for it to go in. Even after 13 years in practice. Yesterday I had a colleague call me in to help her put one in. Is anyone immune?

I have a few pearls if anyone is up for it.


1. If the mouth doesn't work, stick it in the nose, not as much of a curve.

2. Bigger tubes go in easier.

3. Use your other hand to guide it in the mouth.

4. Turn your other hand around and guide the tube between your index and middle finger along the pharynx.

5. Check that the ETT cuff is not over inflated and preventing access.

6. Break out the laryngoscope and magill foreceps and intubate the esophagus with the gastric tube.

Anyone else have other pearls?

I just thought of one....

Throw in an ETT into the esophagus then put the OGT thru the ETT. Maybe I'll try it.

Sounds silly... all for putting in a lil ole G tube.

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[dhb]

Put the tube in the pharynx and flex the patients neck then advance it goes strait in.... most times.

 

[radslooking]

agreed...sit them up if aren't intubated....also flex neck a bit anteriorly...

 

[numbmd]

We're talking the anesthetized, intubated patient, and we're talking usually after the procedure has started.

Another technique: as you are inserting the tube, grab the thyroid cartilage with your other hand and lift up towards the ceiling. This opens up the esophagus, and makes your target bigger. Sometimes helps.

 

[numbmd]

Put the tube in the pharynx and flex the patients neck then advance it goes strait in.... most times.

I agree "most times" but I'm talking about the other times, when you struggle.

 

[fakin' the funk]

I was instructed to grab the jaw (left hand's thumb on the front mandibular teeth, other four fingers on the most anterior part of the mandible) and pull the whole jaw anteriorly. Then insert the tube. A sort of more "invasive" approach to a jaw thrust. It went in easily every time (n = 20).

 

[jwk]

I was instructed to grab the jaw (left hand's thumb on the front mandibular teeth, other four fingers on the most anterior part of the mandible) and pull the whole jaw anteriorly. Then insert the tube. A sort of more "invasive" approach to a jaw thrust. It went in easily every time (n = 20).

n=20? Wow, huge number. NOTHING works "easily every time". Nothing.

 

[ZA_Gasman]

The other option, of course, if the situation allows, is to put it in BEFORE the ETT. I do this for many laparotomies (elective). Do laryngoscopy, get a good sight of the cords, put the OGT behind them and run it down real quick, then bang the ET Tube in. Mission accomplished, and you look real slick - especially if you pre-empt the surgeon asking for the OGT.

I must confess that I too find them Bl*&dy difficult to do when the patient is tubed. TEE also a bit of a struggle to pass at times.... especially under the cardiac screen which seems to move ever closer to our end of the table with each passing day!

 

[pillowhead]

I was instructed to grab the jaw (left hand's thumb on the front mandibular teeth, other four fingers on the most anterior part of the mandible) and pull the whole jaw anteriorly. Then insert the tube. A sort of more "invasive" approach to a jaw thrust. It went in easily every time (n = 20).

i do the same thing and find it works quite well. thumb under the front mandibular teeth and pull straight up--just like a good jaw thrust.

 

[fakin' the funk]

n=20? Wow, huge number. NOTHING works "easily every time". Nothing.

Wow. I think you rather hastily interpreted my use of "n = 20."

My point is that I'm an MS4, I've only done 20 or so, so take my advice with whatever amount of discretion you feel is appropriate.

 

[huktonfonix]

n=20? Wow, huge number. NOTHING works "easily every time". Nothing.

60 percent of the time it works all the time

 

[fakin' the funk]

60 percent of the time it works all the time

It...stings the nostrils. I'm gonna be honest with you Brian...that smells like pure gasoline.

 

[MTGas2B]

One way you can keep the tubes stiffer for your first pass is to keep them in the fridge. We do this at one of our hospitals. If you don't get it quick they warm up and curl the way they always do.