Nosocomial Drownings
Patients sometimes need NG (nasal gastric) tubes inserted. The tube is inserted through the nose and snaked down into the stomach. It's a blind procedure, so sometimes the tube ends up in the lungs. To confirm placement of the tube, we used to push air down it and listen to the stomach. If the stomach gurgled, then it was assumed to be in the proper place. That was a silly test because even when the tube was in the lungs, if air was pushed down it, a gurgling sound could still be heard. This was dangerous because if we fed a patient through the tube when it was in the lungs, the patient would drown.
After I don't know how many deaths and lawsuits, it was finally decided to x ray the patient's chest to confirm correct placement of the tube before starting a tube feeding. This new rule saved the life of one of our patients tonight. The x ray revealed that the nurse had gotten the tube in the patient's lungs. Without the x ray, we would have started the feeding and the patient would have drowned.
Lawsuits aren't always a bad thing. Were it not for being sued we would still be guessing whether a tube was correctly placed and another person would have died tonight. Now, go hug a lawyer.
Written by Melissa on 12:25 AM
Me
Melissa blogging from sunny Santa Clarita, Southern California, United States.
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7 Comments:
Yikes. I am glad mistakes like that are caught.
On the other hand, it would be nice if it didn't take a honkin' big lawsuit to get a hospital to follow best practices. Call me crazy. ;)
Big corporations, like the one I work for, only understand money. Doing something because it's the right thing to do is a foreign concept. They will change only if it is in their financial best interest to change. That is where lawyers and lawsuits come in.
I hate lawyers too sometimes, but they can also be your best friend.
Dear Melissa,
You stated, "it was finally decided to x ray the patient's chest to confirm correct placement of the tube before starting a tube feeding. This new rule..."
I ask, what new rule? It is a hospital policy made into a routine prodecure or a doctor's advice to have the x-ray confirm placemant?
Thank you.
--
George
rad tech, intern.
http://gesses.blogspot.com/
Gesses, this is a new hospital wide policy change. It applies to all patients getting NG tube feedings and no one, including doctors, can override the rule. I hope that the rule applies to all of my employer's other hospitals, but I only know for certain that it applies to ours.
Would it be technically-possible / feasible / less expensive / preferable,
instead of the X-ray to use some type of endoscope (a bronchoscope?)?
What I envision is that the x-oscope would be inserted through the NG tube after
its emplacement, so that one could view the type of surface at the end. This assumes that there is a significant difference in the appearamces of lung and stomach tissues.
Perhaps it could even be pre-inserted in the NG tube (sort of like a trochar)
so that the attendant could view/be-guided-in the insertion process.
Some considerations:
plusses - no radiation, immediate insertion feedback,
reduced probability of patient damage (if trochar-ized);
minuses - training, acquisition/inventory cost,
operating cost (cleaning/sterilization of instrument),
additional patient stress (if separate insertion required).
This is intended as an idea to be kicked around. I have no medical training and
assume no liability if the idea is mis-developed. But, if there are royalties I assign them to Melissa.
I suppose that would be possible, but I doubt that they would allow nurses to do that, so it would increase the costs by requiring doctors. It's cheaper to have a nurse jam a tube down and then X-ray it.
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