Atomized Lidocaine Prior to Nasogastric Tube Placement

Tuesday, 14 July 2009

Michele Farrington, BSN, RN
Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics/University of Iowa Children's Hospital, Iowa City, IA

Learning Objective 1: describe an evidence-based practice to decrease discomfort with nasogastric tube placement for children and adults.

Learning Objective 2: discuss implementation strategies for promoting adoption of an innovative evidence-based practice change.

Purpose:  To implement an evidence-based practice to decrease discomfort and distress with placement of nasogastric (NG) tubes in adult and pediatric patients.

Methods:  Evidence demonstrates that NG tube placement is painful.  At least six randomized clinical trials support the use of topical lidocaine in reducing pain associated with NG tube placement in adults (Cullen et al., 2004; Ducharme et al., 2003; Wolfe et al., 2003; Spektor et al., 2000; Nott & Hughes, 1995; Singer & Konia, 1999), none found lidocaine usage to be ineffective.  Because the clinical trials included only adult patients, additional evidence was reviewed to determine safe lidocaine administration and dosages in pediatrics. At our hospital, patients who need an NG tube placed are screened by bedside nurses for appropriate use or contraindications to atomized lidocaine.  Prior to implementation in June 2008, the procedure underwent review by the Professional Practice Subcommittee, Pharmacy and Therapeutics, Professional Nursing Practice Committee, Nursing Pain Committee, and Nursing Staff Education Committee.  A model was used to guide implementation of the evidence-based changes which included:  educating nursing and medical staff, outreach, and developing a policy and procedure.

Results: Pre-implementation quality improvement surveys were completed after NG tube placement without lidocaine.  For pediatric patients, the mean pain/discomfort score was 7.4 (0-10 scale; n=39). Nursing staff surveys were distributed prior to implementation to assess perceptions of patient pain/discomfort perceived by nurses inserting the NG tube.  Incident reports reviewed prior to implementing the change showed no complications associated with lidocaine use for other pediatric procedures. Preliminary post-implementation data shows some improvement with a mean pain/discomfort score of 5.9 (0-10 scale; n=5).

Conclusion:  NG tube placement can be very painful for patients of all ages.  Nurses and physicians have options available to decrease the discomfort and distress experienced by patients and/or family members during this common nursing procedure.