Painless Nasogastric Tube Placement
A 6-year-old boy presented with intermittent abdominal pain, nausea, and vomiting. Because his abdominal examination was unremarkable, the pain intermittent, and constipation a possibility, we provided an enema along with an abdominal pain workup but no radiographs. His pain improved, the abdominal labs were unremarkable, and the child tolerated an oral fluid challenge after treatment with ondansetron.The mother was advised at discharge to return if she became concerned about her child's condition. They did return a few hours later for increased vomiting and abdominal pain. A CT scan demonstrated multiple dilated loops of small bowel with a collapsed colon and no obvious identifiable transition point. An exploratory laparotomy demonstrated a rare internal hernia resulting from bowel incarceration through a hole in the omentum. The hernia was successfully reduced without complications.But I want to focus on the nasogastric (NG) tube ordered by the pediatric surgery team. The first attempt performed by my nursing colleague without any topical anesthetic was traumatic to the patient and the nurse, who requested assistance, so we reviewed techniques for painless NG tube insertion, specifically how to use an atomization device. Following several small sprays of 4% lidocaine (with viscous lidocaine applied to the tube), the NG tube placement was successful with markedly less pain and resistance from the child.Nasogastric tubes may be the most painful procedure commonly performed...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
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