"Painless" Nasogastric Tube Placement

I said nooo

Using Lidocaine is so weird to me because a placement of an NG tube isn't supposed to hurt. It's very uncomfortable and can trigger the gag reflex but using local anesthetics could possibly mask injuries sustained during the placement.

Give the nurse one fr. the patient gotta be a nurse cuz no one would agree to this lOL

hot nurse!

I’ve had 2 sbo’s & had to have one. They gave me some versed the 1st time. Was in for 4 days. It was hell! It hurt in my face like I was being punched by a linebacker. I’m a retired RN & have placed many ngt’s & managed/removed too. Never had a patient c/o about pain like I was having. It’s normal to have it be irritating but what I was feeling was so beyond that. The tube had to be pushed in a bit & I thought no problem. It hurt so bad I broke down sobbing. It shouldn’t have hurt that bad! I was eventually referred to ENT after dc & I had a CT. Nothing except a deviated septum. My next ngt insertion was ok but should have had a larger one. It was a 10 I think. Ended up having surgery & they replaced it with a 16. No matter how technically smooth it goes in I am still beyond scared. I am subconsciously evaluating even the slightest twinge for possible obstruction.

I had a a bowel obstuction a little over two years ago, and had to have this procedure, I never got any numbing liquid it was just drink the water, let me tell you, I have PTSD after this, now let me tell you I have terminal ovarian cancer and have been through chemo and treatment for the past 4 years, this procedure was by far the worst thing I have every gone through in my life I'd rather have a cut to my stomach and the tube inserted that way than this it is horrific and very unplesant .

I subscribed to your channel Larry. If you can comment on my Mom's experience today I would love to hear your opinion & any suggestion that you may have for her! Thanking you in advance, Daphne from Toronto Ontario Canada!

My Mom had this procedure done today & she couldn't tolerate it. The guy who was doing it wasn't very good in my opinion or hers. To be fair, my Mom did try a second time but it was equally bad as the first attempt. I will state the following facts. The numbing spray they put in her throat & nose (no jelly for the nose) she said tasted like poison. After watching this, I believe that the guy sprayed too much into her throat both times but of course I can't really be sure. All I know is that both times she threw up violently & for a couple of minutes. My Mom has a sensitive stomach & since she was on an empty stomach that just made matters worse. The guy was going extremely slow in putting in the tube, my Mom kept saying "OMG you're so slow! Can't you do it any faster?" The first time, it was almost in place but when she started gagging & then throwing up she just yanked it out on her own. She continued to throw up what little water she drank & then started crying. She said "I can't do this! The combination of the numbing spray & his inability to put in the tube in quick manner caused my Mom so much stress, anxiety & fear!" He actually said to my Mom "don't you want to find out what is wrong with you? You have to do this, so let's try again. My Mom said please give me a few minutes to think about it & let me calm down from this horrible event! My Mom then agreed & said, I will try 1 more time so nobody can say I didn't try. He asked her if her throat was still numb & she said yes, then he said let me put some more, to which she said no I don't want anymore because it's making me sick to my stomach. He insisted & she agreed. A second spraying was done & she started to gag & throw up again. I tried my best to support my Mom & told her you can do this Mom, I'm right here, hold my hand ok? He did exactly the same procedure as the first time & once again she started to violently gag & vomit everywhere. Oh yeah, my Mom was wearing her street clothes & they didn't even give her a gown to change in so she just vomited all over herself, sad. I felt so bad for my Mom. This guy (technician or whatever they are called) was not sympathetic or empathetic to my Mom, he just stood there like a robot while she was hurling her guts out everywhere! Didn't offer her kleenex or a barf bag! He was a dirt bag in my opinion. We were at Toronto General Hospital in Toronto Ontario Canada.

My Mom was diagnosed with stage 4 Cirrhosis of the Liver a year ago so this was our second time at this hospital. So, after the second attempt the guy said why don't you go & wait in the waiting area & I will take my next patient & we can try again after I'm done. My Mom said a big fat NO! No thank you sir! I asked the guy "do other people have as much trouble as my Mom did today?' He said yes, it does happen from time to time as everyone is different. I remember at one point the guy saying something to my Mom & all I remember her saying was "I know myself better than you know me & I know what my limits are! You know nothing about me so don't talk to me like you've known me all my life & know what I can or can't do!' This guy just had no heart. I felt like this was just a "JOB" for him & he was clearly missing the aspect of what a medical professional should have towards "helping people" He told my Mom to pretend that she was drinking a beer or a cocktail & try to use "mind of matter" to overcome the wretched taste of this numbing spray. She replied, "I don't even drink alcohol OMG!" So we are home now & my Mom will be calling her Gastroenterologist to see where she goes from here. Her liver biopsy is scheduled for next Monday & when she asked to have sedation for the procedure they denied her & said "normally everyone is awake during this procedure" OMG, I don't think my Mom will be able to go through with the biopsy without sedation but she's a trooper in my eyes & like today, she said "all I can do is try right?" If I can do it then great, if not, then I can't. People have limitation to what they can cope with & this guy did nothing to ease my Mom's anxiety or try to help her relax no, his response was, "if you don't do this procedure today you will not be able to find out what is wrong with you, so don't you want to know why you're sick?" To say the least, my Mom is upset & not happy with the result today. I'm very unsatisfied with how the procedure was done. Oh by the way, my Mom was not told that she was having 2 procedures done today. She thought she was just having an ng tube put in & kept there for 24 hours. She was not made aware that she would be having a camera inserted for 10 minutes to take pictures of her swallowing. System failure. Canada's Healthcare System has been nothing but a failure ever since Covid & the Hospital's here in Toronto Canada fail to provide adequate medical services to my Mom (I would never presume to speak for the entire City of Toronto or Canada, only what she's been through) I asked if there was another option that could be done since today was a complete failure & he said very plainly, NOPE. He was a man of few words. He didn't say goodbye to either of us, he didn't give any words of encouragement to my Mom, like hey good job, you tried twice so I will give you credit for that, no. He offered nothing.

If anyone would like to leave me a comment or ask me any question about today please feel free. If anyone has any advice, I would greatly appreciate it. I read quite a few comments about other people's experiences & it seems to very from person to person. Some great, some bad & some horrific. I can say that watching my 57 yr old Mom go through this today was difficult for me. She's a strong woman who's been through 2 c-sections, a knee operation, a snowmobile accident that caused her chronic back pain now for 32 yrs., it took her 9 months to walk again & steroid injections in her spine...so I know she's tough but today this procedure kicked her in the butt & I'm 99.9% sure that this guy (tech) was the sole reason she couldn't do it. Can you believe that after what she went through today she's going to actually try again? She is going to ask to go to another hospital, have NO NUMBING SPRAY this time & ask that it be a SENIOR TECH perform the procedure & not some 20 something tech with barely any experience with an NG tube!

If you read my comment (story more like LOL) thank you. I just had to get this off my chest. My MOM is resting now. If you would like to pray for my Mom that would be so great, we need prayers for healing & for her biopsy next Monday! Take care & have a Blessed day everyone!

I have recently been seen in ER for a small bowel obstuction and had to decompress with NG, but funny thing is the ER instead of using lidocaine put the NG tube in the freezer to help cool the tube to slide it in better. As an EMT I never heard such of thing.

What a way of product promotion of that Lidocaine 2% with that pretty E.R nurse.

It is my #1 fear in life to need to get one of these. They terrify me.

What the hell do you guys do in the states and what gauge NG tube. I just had one of those no lignocaine needed just a trained nurse and correct timing with swallowing it was over quicker than you guys squeezed the anaesthetic out of the tube. Is it done like this for the insurance or what. It was uncomfortable for about 10 seconds but not painful.

Shit, I remember getting one of those things, only I don’t think I got those numbing meds before it went it, and there wasn’t a swallowing phase, to be fair I was recovering from a head injury and would fight back if I could

As medically good as those things are, even long after mines been removed, I still HATE that thing, even after it painfully went in it was very uncomfortable for the week and a half it was in there

And to prove my brain was damaged I called the people who did it assholes after it was in 😂

What is the patient doesn't want to swallow

Had one of those recently I was gagging I never want one of those tubes ever again 😮 but it did do it’s job had a SBO it was painful

Did not look painless.

Very helpful video thanks Larry ❤

That was very helpful.

I’ve had three ng tubes and never was I given a sedative or lidocaine.

NG tubes hurt so bad I remember when I was 7 they had to get 4 other nures to hold me down lol

I've had NJ tubes that turned into ng and they hurt I had them take it out right after. They said well we can only take out ng not NJ and I told them if I'm puking up the formula it's in my stomach.. I got like the tip of the catheter with the lidocaine jelly and the rest was lube, this looks way less painful

There’s no such th g as painless nah tube

Let me say it is hella painful without lidocane going in and coming out

I like tat the “painless” is in quotations. The nurse acted like she was so confident in what she was doing yet didn’t do anything quite right. I hope that it was a good learning opportunity for her! Also, kudos to the girl that was brave enough to have this done. What a great way to learn how to do something!

Had it done, and told my Doc never again knock me out bore a hole in my side and feed me with a shovel! This day and age this procedure is voodoo!

This was cool. I would actually volunteer just to see how it feels 🙃

I have almost gotten this done before I am eleven but I almost had a panic attack when they suggested putting one in because I have had traumatic covid tests.

I prefer no numb. It shouldn't hurt and if it does you need to stop. I prefer to know

I remember getting in of these as a kid. Absolute torture, nurses holding me down no numbing at all. Traumatized me. Getting a covid test done triggers that fear.

I’ve been a registered nurse for over twenty years and I’ve only used ever KY. But the last NG tube I inserted was about 18 years ago. Would’ve been nice to have all these extra goodies to use (especially all that lidocaine!)

This makes me so mad because when I had an NG tube placed in the ER for a partial bowel obstruction the nurse didn't give me ANYTHING. It is a form of torture. I told my family if I ever have to have an NG tube again, just let me die. I wouldn't wish it on my worst enemy.

Ich hab die Dinger einfach durch die Nase geschoben bekommen. Ohne Betäubung, ohne Wasser... Dass das betäubt werden kann und man dabei Wasser schlucken kann wusste ich gar nicht 😕🤔

Trust me it sucks

Hold me down or knock me out if you have to do it on me.

All I know is I can't let this young woman show me up, she volunteered I guess if I have to have it done to me, Just do it!!!

Y'all get anaesthesia and a glass of water during it? Is that common practice? The doctor I saw just shoved it down without anything else.

Consider Lidocaine nebulizer

Thank you for sharing and continuously making these videos Dr. Mellick and team!! You’re helping us nursing students A LOT! 💯💖🙏🏼 YALL ARE AWESOME HUMAN BEINGS THANK YOUUU! 👏🏼

We don’t use lidocaine ever in the UK. It would be only in extreme instances. I’m the queen of NJ placements in critical care as I always get it in quickly and with minimal pain or difficulties. I’m also a crohns patient and I have spent too much time in hospital and have had many NJ placements. I generally will place my on NJ tubes as the staff know me and I can again do it quickly and seamlessly myself so unless I’m currently vomiting and wrenching it’s easier to just let me do it lol !

I wish it was you guy who put mine in many years ago, would have to be the worst medical experience I've ever had

А почему перевода нет.

Trauma Nurse here. Doc I love your channel so I do apologize if I said like a jerk but this video is sort of a waste of time in a busy ER setting. This technique gives the patient a notion that this procedure is not going to hurt which is misleading and they maybe disappointed. Plus keeping the NGT STRAIGHT as you insert......I see that (word removed) all the time and that is horrible. Always curl the tip 3-4times around your finger tightly for about 1 min before applying jelly to the tip. Why stick a straight semi flexible tube (16-18f) into a concave passage?! curl the tip for a more natural insertion.
The technique that works for me which may take as much time as this video is making the patient activity participate.
We (the pt and I) "practice" minus the tube.
1. "keep your head straight and breath through your mouth. that's your job, to breath through your mouth not your nose"
2. I tap the nose to mimic no insertion. "don't focus on me messing w your nose, focus on breathing through your mouth. I'm inserting the tube".
3. "chin to your chest. keep the mouth breathing going you're doing great. I'm now at the back of your throat."
4. "my assistant will give you the straw to start sipping. keep your chin to your chest. this position opens up your esophagus. YOU HAVE TO DRINK NOT HOLD THE WATER IN YOUR MOUTH. AGAIN DRINK THE WATER NOT HOLD THE WATER. DRINK THE WATER".
I let them actually take a tiny sip of ice water.
5. I tell my assistant "when you feel the straw get cold from the ice water say DRINK. I hear DRINK and we both chant it together as I advance the tube.
We, practice this about 5 times the patient and I.
"Giving them a job to do" vs. "having something done to them"....huge difference . Even patients with strong gap reflexes I can pass it down after "We Practice".
after the insertion is complete and taped to the nose. I ask the doc for lido viscous order for the pt. I usually give 1 tsp for the first 1-2 hrs til the patient is actually admitted and leaves the ER.

Confirming NG placement by auscultation of an air bolus is not evidence-based, get an x-ray and check residual pH.

Painless? Lol... not so sure its painless. I've never had a painless one. But certainly not excruciating. Quite uncomfortable after placed also. Miserable to have for any length of time.

I was supposed to get an ng tube placed in my intestines but when they tried, the student stuck it down my esophagus. No lidocain(idk how to spell it lol) hardly any lube. I tried signaling her to stop and that I can't breath but she just said thats normal and kept going. I never got my heart medicine that day either so when I couldn't take it anymore I fell back and snatched the tubing all the way out myself.

I'll tell you that is a lot better then when they tried to get that tube in my nose omg. Felt like that lady was trying to pierce my brain I was in tears.

This makes me want to gag

You know... I think doctors should go through procedures like this just to be able to see where the procedure could be polished up (like when you talked about the numbing and the resistance,) but also so they have more compassion and understanding as to what their patients go through. Some doctors plow ahead and overlook the little ways that will help make a world of difference comfort wise for their patients....

I’m not watching this cos it will trigger my ptsd from my long stay in paeds and then a psych ward for anorexia (even though I actually had and have severe ocd and my compulsion was to starve myself for 14 years). My 1st NG tube hurt so much. My second hurt less. By the 3rd my favourite nurse decided to take over changes and she could do it so quick and gently it was barely worse than a blood test. It’s all about the skill. Lube and lidocaine help but it’s mostly the nurse doing the procedure in my experience. Thanks Sandra!!

Not sure what would be worse, all the fuss with lidocaine or just a well lubricated NG tube, good patient positioning, and a full cup of water. If you set yourself up for success it is quick and easy. Just whatever you do, don’t place it in the spinal column.