struggling with OG tube placement

[heathermed]

I know this sounds like a really basic question... but I figure I'd ask it anyway at the risk of sounding silly.

Does anyone have any tips for OG tube placement?
for whatever reason, I'm really struggling with this task.
I've tried pulling the jaw up each time but I'm almost at a 50% success rate.

very troubled 🙁

thanks for all the help

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[okayplayer]

NG instead

 

[caligas]

Follow the et tube down. Usually goes in the the esoph that way.

 

[nap$ter]

sometimes you have to use a laryngoscope and a magills, but first,

don't lift the jaw - grab the larynx (by the skin atop it) and lift it up as you advance the tube.

use a fresh cold tube.

 

[Gimlet]

don't lift the jaw - grab the larynx (by the skin atop it) and lift it up as you advance the tube.

This! Just learned this trick recently and it's a game-changer. Grab a good hunk of the pre-tracheal skin and lift, or even get a wider grip around the thyroid cartilage.

 

[MasterHypnotist]

In the most difficult cases in an ICU pt, I have used glidescope with Magill to place an OG/NG.

 

[urge]

Push hard. If it doesn't go push harder. If you get frank blood you are probably in the heart amd thus can bill as a central line insertion.

Disclamer: just kidding. Do not attempt.

PS: Yes, I'm afraid someone is going to do it. My faith in people looking at this forum is that low.

 

[deleted126335]

Go to technique when the tube just won't go. After removing the Connector, Take a scissor and cut a larger endotracheal tube down the long axis the length of it. Lube it well inside and out. Deliberately insert it in the esophagus. Slide O/G or N/G down tube. Now peel the endotracheal tube off leaving the gastric tube behind.

 

[EdPierce]

you just want to avoid it coiling. if you avoid coiling it will find its way in. i often put my finger in the posterior oropharynx and use it to guide the tube against the pharyngeal wall and to not coil.

 

[racerx]

you just want to avoid it coiling. If you avoid coiling it will find its way in. I often put my finger in the posterior oropharynx and use it to guide the tube against the pharyngeal wall and to not coil.

+1

 

[fakin' the funk]

Fresh tube. The bigger, the better. Lube. Start midline, stay midline. As you advance, use your thumb and forefinger of the other hand to pinch the airway just cephalad to the hyoid. This pinches off the vestibules, compresses the airway cross-section, and makes the esophagus the only place the OGT can go..

 

[deleted59964]

try

neck flexed
fingers down oropharynx
deflate the ETT cuff slightly - sounds bizarre I know ...

 

[KLPM]

Push hard. If it doesn't go push harder. If you get frank blood you are probably in the heart amd thus can bill as a central line insertion.

Disclamer: just kidding. Do not attempt.

PS: Yes, I'm afraid someone is going to do it. My faith in people looking at this forum is that low.

http://www.ncbi.nlm.nih.gov/pubmed/15636338

Do these guys get to bill for ventricular shunts?

 

[Dejavu]

I know this sounds like a really basic question... but I figure I'd ask it anyway at the risk of sounding silly.

Does anyone have any tips for OG tube placement?
for whatever reason, I'm really struggling with this task.
I've tried pulling the jaw up each time but I'm almost at a 50% success rate.

very troubled 🙁

thanks for all the help

I have struggled with gastric tubes for 37 yrs. Do not feel alone out there. It is easier to place a central line than on OG/NG tube.

I have tried all the tricks mentioned except the split ET tube idea. I plan on trying that the next struggle with one.

My impression after all this time? Some go where you want, some don't.

If the surgeon can reach up and help you place it from the abdominal wound end, sometimes that helps.

 

[davefromcamp]

Go to technique when the tube just won't go. After removing the Connector, Take a scissor and cut a larger endotracheal tube down the long axis the length of it. Lube it well inside and out. Deliberately insert it in the esophagus. Slide O/G or N/G down tube. Now peel the endotracheal tube off leaving the gastric tube behind.

+1 for the super tough ones. I agree I hate OG tubes. I'd try it a couple times before wasting an ETT!

 

[mysticfolken]

I've found that when meeting resistance, instead of putting more pressure and forcing it down (and possibly causing it to coil), using a "bouncing" technique with quick jabs to advance allows you get by the resistance and down into the esophagus.

Also, 18F tube over smaller tubes...stiffer tube, less coiling. I also wind the distal tube around my hands to shape the curve of the tube a bit before inserting.

 

[susruta]

I always like to keep an eye on the circuit leak when I insert a gastric tube. Seen them slip into into the trachea twice with Ett in place.

Sent from my GT-N8013 using Tapatalk 2

 

[btbam]

I always like to keep an eye on the circuit leak when I insert a gastric tube. Seen them slip into into the trachea twice with Ett in place.

Sent from my GT-N8013 using Tapatalk 2

If they are on the vent and you hook it up to suction, you will know right away if you are in the trachea cause the bellows will slam down.

One other trick is to "aim" the tube towards one side or the other. The whole time I'm advancing it, I try to push the tube to the right which helps avoid coiling.

 

[deleted9493]

I seem to have higher first success with rotating the head to one side or the other before insertion. Seems to help with TEE probe insertion, too.

 

[okayplayer]

sometimes you have to use a laryngoscope and a magills, but first,

don't lift the jaw - grab the larynx (by the skin atop it) and lift it up as you advance the tube.

Thanks for this tip guys. N=1 yesterday but it went right in the first try.

 

[sunnyINphilly]

If the above techniques don't work, try taking the ETT cuff down briefly, and then try passing the the NGT/OGT. Given its position, an inflated cuff may be compressing the esophagus via the circumferential cricoid cartilage, and thus obstructing the OG near the UES