A nasogastric tube is a device that we could see on movie characters who are in a coma. Filmmakers, wanting to convey the epic nature of the moment, “stuff” the actor-patient with a variety of medical devices. And the probe, which is visible to the viewer as a pair of thin tubes going into the nose, is one of my favorite techniques. Although, in fact, this device is not always installed, and its use requires serious indications.
In what cases is a gastric tube installed?
You don’t need to be a doctor to know approximately what a nasogastric tube is used for. Because its purpose is clear from the name itself. Translated from Latin nasus - this is the nose, and gastritis from Greek – stomach. Those. The tube is passed through the nasal passages into the stomach so that food and medicine can be given through it in the future.
The main indication for the use of a tube is the inability to feed independently. And this can happen in different cases.
- Acute pancreatitis.
- Fistulas in the esophagus.
- The esophagus is narrowed enough to allow a thin tube to be inserted.
- Injuries to the abdomen, throat or tongue.
- The patient is in a coma.
- Refusal of food and vital medications due to mental disorders.
- Impaired swallowing function due to damage to nerve endings (this happens, for example, after a stroke).
- Postoperative period after surgical interventions on the stomach, intestines, pancreas.
By the way! Bringing food and medicine into the stomach is not the only function nasogastric tube. It can also work in reverse side. And sometimes it is installed to drain the stomach cavity, i.e. to remove foreign liquids from it, for example, during or after abdominal operations on the gastrointestinal tract.
Operating principle of the probe
Gastric tube photo
The nasogastric tube is made of non-toxic PVC or silicone that is resistant to gastric juice.
The tube is hollow and thin enough to fit through natural channels human body. But at the same time, it freely allows liquid food and medicinal solutions to pass through.
A probe into the stomach is installed for a period of 2 to 3 weeks, depending on the material it is made of. Then you should remove it and install a new one.
Placement of a nasogastric tube, algorithm
The installation procedure takes only 5-10 minutes. It will not be painful for the patient if he listens carefully to the doctor and does everything as he says. Discomfort, of course, cannot be avoided, but it is quite tolerable.
Before the installation of a nasogastric tube begins, a conversation is held with the patient, during which he is told the need for this manipulation and the possible consequences in case of refusal to insert the tube. Having received consent, the doctor gives the patient a short briefing, explaining how to behave during the procedure. Then the manipulations begin.
- The patient is asked to blow his nose to clear the nasal passages.
- He then closes each nostril in turn to see which one allows air to flow more freely.
- The length of the tube is measured individually for each person.
- The end of the probe is lubricated with glycerin to move more freely and reduce patient discomfort.
- The tube is inserted approximately 15 cm. The patient is then asked to make swallowing movements, which will facilitate further advancement. For convenience, a person is given water to drink through a straw.
- After installation, the patient’s ability to breathe freely is checked, and their condition and sensations are inquired about. If everything is fine, you can start the first feeding.
By the way! The nasogastric tube is inserted in a half-sitting, half-lying position. This is the most anatomically successful position in which the course of the tube is not blocked by anything.
With patients who are in very serious or unconscious, everything is a little different. They cannot help the doctor with swallowing movements and report their sensations, and then the doctor has to act intuitively. In extreme cases, when a person has serious damage to the nasal passages, esophagus or stomach, the placement of the probe is carried out under ultrasound guidance.
Feeding through a nasogastric tube
Meals are provided at the frequency determined by the attending physician. Patients in a coma are usually fed less frequently. Those who are conscious may experience a regular feeling of hunger, so the patient is fed through a tube at least 3 times a day. Used as nutritional mixtures regular food, only ground or diluted with water to a liquid state. This can be milk or cream, broths, vegetable soups, jelly, fruit juices, tea.
By the way! Because the feeding tube is too thin and cannot pass certain types of food; vitamins are necessarily added to the mixtures, which the patient cannot obtain through nutrition.
Nutrient mixtures are supplied using a syringe. It is inserted into the end of the probe. After feeding and administering medications, the tube must be washed with warm boiled water. At the same time, this is a drink for the patient. After all the manipulations, the end of the probe is closed with a plug to prevent dust and foreign objects from entering the stomach.
Possible complications after installation
Any medical manipulation associated with risks. And even with full compliance with the technique of placing a nasogastric tube, complications cannot be ruled out. Most often, bleeding occurs due to damage to the mucous membranes during the passage of the tube through the passages or as a result of nasal bedsores. Non-serious complications also include throat diseases (pharyngitis, tracheitis), because the patient is forced to breathe through his mouth. Reflux esophagitis also often develops - the entry of gastric contents into the esophagus.
A more serious complication of tube installation is perforation (damage to the walls) of the esophagus, pneumothorax and infectious diseases in the form of abscesses of the larynx or retropharyngeal area. Such consequences require long-term treatment, up to the need for surgery.
The professionalism of the medical staff and full compliance with all the rules of the procedure will help to minimize the possibility of complications and increase the patient’s comfort during the installation of the probe. The patient himself can also contribute to all this by unquestioningly following medical recommendations.
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Tube insertion technique, tube diets
In cases of prolonged disturbances of consciousness or the presence of a persistent swallowing disorder, the issue of placing a gastric tube and organizing therapeutic nutrition through a probe.Nasogastric tube
1. Indications:a) enteral nutrition in case of impaired consciousness and swallowing, etc.
2. Contraindications:
b) head injuries with a possible fracture of the base of the skull.
3. Anesthesia. Topical aerosol lidocaine is not required or can be used.
A) gastric tube;
c) syringe (60 ml or Janet);
d) stethoscope;
e) a cup of water;
e) a cup with ice.
5. Position: sitting or lying on your back.
6. Technique.
6.2. Some anesthesiologists place the tip of the probe in a cup of ice to stiffen or bend it. This maneuver helps more easy implementation tube into the proximal esophagus.
6.3. Lubricate the tube with Vaseline (glycerin).
6.4. Ask the patient (if they are conscious) to flex their neck and gently insert the tube into their nose.
6.5. Insert the tube into the nasopharynx, pointing it posteriorly and asking the patient to take a sip if possible.
6.6. Once the initial part of the tube has been swallowed, ensure that the patient can speak freely and breathe without difficulty. Smoothly move the tube over the set distance. If the patient is able, ask him to drink water through a regular straw, while passing the probe as he sips.
6.7. Correct placement of the probe is confirmed by injecting approximately 20 ml of air through the probe using a syringe. At the same time, performing auscultation in the epigastric region.
6.8. Carefully secure the tube to the patient's nose using adhesive tape. The tube must be kept lubricated at all times to prevent erosion of the nasal mucosa. The tube can also be secured to the patient's underwear using a patch or pin.
6.9. Every 4 hours the tube should be flushed with 30 ml of saline solution.
6.10. Depending on the type of probe and its purpose, aspiration from the tube is carried out periodically or continuously.
6.11. Gastric pH should be monitored every 4-6 hours and adjusted with antacids, keeping it below pH 4.5.
6.12. The nature of the secreted gastric contents should be monitored, especially when performing enteral nutrition. It is advisable to use plain radiography chest necessary to confirm correct tube position before using it for enteral feeding.
6.13. Ideally, the tube should not be blocked by a clamp. The tube constantly keeps the esophagus open, increasing the risk of aspiration, especially if the stomach is distended.
7. Complications and their treatment:
7.1. Unpleasant sensations in the pharynx: quite frequent, due to the large diameter of the probe used, can be relieved by a sip of water. Aerosol anesthetics of the pharynx should be avoided, as they may inhibit the reflex, which is necessary for protection respiratory tract.
7.2. Erosion of the nasal mucosa. This complication can be prevented by keeping the tube constantly lubricated and securing it with adhesive tape without causing high blood pressure on the wall of the nasal passage. The tube should always be below the nose and never attached to the patient's forehead. Frequently checking the correct position of the tube can help prevent this problem.
7.3 Sinusitis. Occurs with prolonged use of a nasogastric tube and requires removal of the tube and placement through the other nasal passage. Antibiotic therapy is required.
7.4. Nasotracheal intubation (erroneous placement of a probe into the airway). Leads to airway obstruction and is diagnosed quite easily in patients who are in normal consciousness (cough, unable to speak). Proper placement of the probe requires a chest x-ray.
7.5. Gastritis. Usually manifests as minor, self-limiting, gastrointestinal bleeding. Prevention of this complication consists of maintaining gastric pH below 4.5 with antacids given by tube, IV H2 blockers, and, if possible, early removal of the tube.
7.6. Epistaxis ( nose bleed). Usually resolves on its own. If bleeding continues, remove the tube and determine the location of the bleeding. Treatment of epistaxis requires nasal tamponade.
Orogastric tube
The indications are basically the same as for a nasogastric tube. However, since this procedure It is quite poorly tolerated by a conscious patient; the procedure is most often performed on patients undergoing intubation (during endotracheal anesthesia, mechanical ventilation, etc.) and newborns. Orogastric intubation is preferred for gastric decompression in patients with head trauma with possible basal skull fracture.1. Indications: enteral nutrition for disorders of consciousness and dysphagia.
2. Contraindications:
a) recent surgery of the stomach or esophagus;
b) head injury with possible fracture of the base of the skull.
3. Anesthesia. Topical applied lidocaine is not required or can be used.
4. Necessary equipment:
a) gastric tube;
b) glycerin (or other substance for lubricating the tube);
c) syringe (60 ml or Janet);
d) stethoscope.
5. Position: lying on your back.
6. Technique:
6.1. Measure the tube from the mouth to the eyebrow and down to the front wall of the abdomen so that the last hole of the probe is below the xiphoid process. This indicates the distance the tube must be inserted.
6.2. Lubricate the tube with Vaseline (glycerin).
6.3. Because patients undergoing orogastric intubation are usually unable to assist during the procedure, the tube must be placed in the mouth, directed posteriorly until the tip of the tube begins to advance into the esophagus.
6.4. Advance the tube slowly and steadily. If any resistance is felt, the procedure should be stopped and the tube removed. Repeat step 6.3 again. If the tube moves easily with minimal resistance, continue passing it the previously measured distance. The presence of resistance or coiling of the tube, or hypoxia indicates improper placement of the tube in the trachea.
6.5. Correct placement of the tube is confirmed by injecting approximately 20 ml of air through the tube using a syringe while auscultating the epigastric region. Also, correct placement of the probe can be confirmed by aspiration of a large volume of fluid.
6.6. Every 4 hours the tube should be flushed with 30 ml of saline solution.
6.7. Depending on the type of probe and its purpose, aspiration from the tube is carried out periodically or continuously.
6.8. The pattern of gastric contents released must be monitored, especially if used for enteral nutrition. Survey radiography chest wall is necessary to confirm correct tube position before using it for enteral feeding.
6.9. Gastric pH should be monitored every 4-6 hours and adjusted with antacids, maintaining below pH 4.5.
7. Complications and their treatment.
7.1. Unpleasant sensations in the throat may occur in conscious patients, therefore this type They do not use intubation, with the exception of patients on mechanical ventilation.
7.2. Tracheal intubation. Correct placement of the probe is confirmed by its easy passage into the esophagus. Any resistance indicates that the tube is lodged in the trachea or is coiled at the back of the throat. Proper placement of the probe requires a chest x-ray.
7.3. Gastritis. Usually manifests itself as minor, self-limiting gastrointestinal bleeding. Prevention of this complication consists of maintaining gastric pH below 4.5 with antacids given by tube, IV H2 blockers, and, if possible, early removal of the tube.
A.P. Grigorenko, Zh.Yu. Chefranova
Target: introduction into the body nutrients, feeding the patient.
Indications: difficulty swallowing, damage to the tongue, pharynx, larynx, esophagus, after surgery on the esophagus, disorders of the central nervous system, unconsciousness, mental disorders with refusal to eat.
Contraindications: injuries of the esophagus, bleeding of the esophagus and stomach, varicose veins veins of the esophagus.
Equipment:liquid food: sweet tea, fruit drink, raw eggs, butter, milk, cream, fruit juices, jelly, baby nutritional formulas “Baby”, “Infamil”, etc. in the amount of 600-800 ml., special preparations: enpits,
sterile thin gastric tube, glycerin, funnel or Janet syringe, 30-50 ml boiled water, phonendoscope, bandage, adhesive plaster, probe plug, 20 g syringe, container with disinfectant. solution, gloves.
I. Preparation for the procedure
1. Collect information about the patient, introduce yourself kindly and respectfully.
2. Explain the essence and course of the upcoming procedure and obtain his consent.
3. Prepare the necessary equipment.
4. Wash and dry your hands and put on gloves.
II. Carrying out the procedure
5. Place the patient in a position comfortable for feeding (sitting, lying, Fowler’s position), cover the chest with a napkin.
6. Examine the skin and mucous membranes of the nasal passages. If necessary, clear the nasal passages of mucus and crusts.
7. Determine the distance to which the probe should be inserted: from the xiphoid process to upper incisors (upper lip) and up to the earlobe, put a mark.
8. Moisten the probe with water or treat it with glycerin.
9. Insert the probe through the nasal passage to the desired depth.
10. Monitor the position of the probe in the stomach: draw 30-40 ml of air into the Janet syringe, attach it to the probe and insert it into the stomach under the control of a phonendoscope (characteristic sounds are heard).
Remember! Without making sure that the tube is in the stomach, do not start feeding.
11. Apply the clamp and disconnect the syringe from the probe. Place the free end of the probe into a container.
12. Before feeding, remove the clamp from the probe, draw liquid food into the Janet syringe and connect it to the gastric tube. The Janet syringe can be replaced with a funnel. In this case, hold the funnel slightly inclined at the level of the stomach and pour the prepared food into it. The higher the funnel, the faster the food flow rate. The required volume of the mixture is administered fractionally, in small portions of 30-50 ml with intervals of 1-3 minutes between them. at a temperature of 37-38°C.
13. After feeding, rinse the tube with water.
14. Close it with a stopper. Secure the end of the tube with an adhesive plaster or a strip of bandage until the next feeding. Before each feeding, you need to make sure that the tube is in the same place. When feeding dairy foods, rinse the tube every 2 hours. Pour in food slowly, start with 5-6 one meal in small portions, gradually increasing the volume of food introduced and reducing the number of feedings.
15. Inspect the linen in case of replacement.
III. Completing the procedure
16. After feeding, remove the probe and place it in a container with disinfectant. solution.
17. Remove gloves, place them in a container with disinfectant. solution
18. Wash your hands
19. Make a record of the procedure and the patient’s reaction to it in medical documentation.
Note: The length of time the probe remains in the stomach is determined by the doctor.
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Rice. 55. Feeding through the NGZ using a Janet syringe
NUTRITION THROUGH GASTROSTOMY
Gastrostomy - Greek. gaster - stomach, stoma - hole.
A gastric fistula is surgically created for the patient, through which a probe is inserted and food enters directly into the stomach. The amount of food and frequency of feeding is determined by the doctor.
Target: feeding the patient.
Indications: inability to take food in other ways, esophageal obstruction, pyloric stenosis.
Equipment: gastric tube, funnel or Janet syringe, 30-50 ml of boiled water, bandage, adhesive plaster, plug for the tube, containers with disinfectant. solution, gloves, sterile wipes, scissors, gels and ointments as prescribed by a doctor, nutritional mixtures as prescribed by a doctor in the amount of 200-500 ml, temperature 37-40°C; liquid food: sweet tea, fruit drink, raw eggs, butter, milk, cream, fruit juices, jelly, nutritional mixtures containing proteins, fats and carbohydrates, etc.
I. Preparation for the procedure
1. Explain the purpose and course of the upcoming procedure to the patient (who is conscious) and relatives. Tell him what he will be fed.
2. Obtain the patient’s consent to perform the procedure.
3. Help the patient find a comfortable position.
4. Wash and dry your hands.
5. Wear gloves.
II. Executing the procedure
7. Attach a funnel or Janet syringe to the rubber tube.
8. In small portions (50 ml) 6 times a day, introduce warmed food into the stomach.
Note: Sometimes the patient is advised to chew the food himself, then dilute it in a glass with liquid and pour it into a funnel in a diluted form. With this feeding option, reflex stimulation of gastric secretion is maintained.
9. After introducing food, rinse the rubber tube with 40-50 ml of boiled water.
10. Clamp the tube with a clamp, disconnect the syringe, close the tube with a stopper.
11. Make sure the patient feels comfortable.
III. Completing the procedure
12. Place the used instruments in a container with disinfectant. solution.
14. Wash and dry your hands.
Remember! Do not introduce a large amount of liquid into the funnel because due to spasm of the stomach muscles, food can be thrown out through the fistula.
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Rice. 56. Feeding through a gastrostomy tube
PARENTERAL NUTRITION
(bypassing gastrointestinal tract)
Target: restoration of impaired metabolism in case of organic and functional failure of the gastrointestinal tract.
Indications: obstruction of the digestive tract, when normal nutrition is impossible (tumor), after surgery on the esophagus, stomach, intestines, preparing exhausted and weakened patients for surgery, anorexia (lack of appetite), when refusing to eat, uncontrollable vomiting.
Equipment: drip system, sterile tray, sterile gauze pads, adhesive tape, 70% alcohol, sterile cotton balls, protein preparations, fat emulsions, carbohydrate preparations, saline solutions, hypertonic solutions.
Algorithm of actions nurse:
I. Preparation for the procedure
1. Explain the purpose and course of the upcoming procedure to the patient and relatives if he is encountering it for the first time.
2. Obtain the consent of the patient or his relatives for the procedure.
4. Wash ( hygienic level) and dry your hands.
5. Wear gloves.
6. Prepare the necessary equipment.
7. Before administration, the agent for parenteral administration is heated in a water bath at 37-38°C.
II. Executing the procedure
8. Fill the system for drip administration of nutrients.
9. Connect the system for intravenous administration to the patient.
Protein preparations:
Amino acids:
· hydrolysine,
· casein protein hydrolyzate
Protein preparations are administered at a rate of 10-20 drops per minute in the first 30 minutes, then 40-60 drops per minute. Faster management is not advisable, since excess amino acids are not absorbed and are excreted in the urine.
Fat emulsions:
Lipofundin S
· intralipid
Fat emulsions are administered in the first 10-15 minutes at a rate of 15-20 drops per minute, then 60 drops per minute.
Administration of 500 ml of the drug lasts approximately 3-5 hours. With the rapid administration of a fat emulsion, the patient may experience a feeling of heat, facial flushing, and difficulty breathing.
Carbohydrate preparations:
· glucose solutions 5-10% - 25%.
Saline solutions(isotonic or physiological):
· 0.9% chloride solution sodium
· 1.5% sodium bicarbonate solution
· 0.9% ammonium chloride solution
· 1.1% potassium chloride solution, etc.
The rate of administration is 30-40 drops per minute.
· 2%, 3%, 10% sodium chloride solutions.
The rate of administration is 30-40 drops per minute.
Note: Parenteral nutrition solution can be prepared as needed from available ready-made solutions. 5 and 10% glucose solutions are used as the main ones, to which are added the corresponding amounts of 15, 20, 30, 40 ml of 10% NaCl solution, 20-30 ml of 10% KCl solution, 0.5 -1 ml 25% magnesium sulfate solution, 1-2 ml 10% CaCl solution.
Remember! The rate of drug administration must be strictly observed.
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Rice. 57. Parenteral feeding of the patient
III. Completing the procedure
12. Disinfect and dispose of the disposable drip system.
13. Remove gloves and put them in a container with disinfectant. solution followed by disinfection and disposal.
14. Wash and dry your hands
15. Make a record of the procedure and the patient’s reaction to it in the medical documentation.
Feeding through a nasogastric tube (NGT) is carried out if the patient’s normal nutrition through the mouth is impossible.
This happens with certain diseases of the oral cavity, esophagus, stomach (trauma or swelling of the esophagus or larynx, swallowing disorders, tumors, etc.), as well as when the patient is unconscious.
↯ More articles in the magazine
The procedure is contraindicated only in case of a stomach ulcer during its exacerbation. It is carried out by a nurse who is fluent in the methods and techniques of feeding a patient through a tube.
The main thing in the article:
Preparing formula for feeding
Samples and special selections standard procedures For nurses, which can be downloaded.
With intermittent (fractional) tube feeding mode
With intermittent feeding through a tube, the algorithm of actions will be as follows:
- Prepare the nutrient mixture and place it in a clean container.
- Fill the feeding syringe with 20-50 ml of nutritional mixture.
- Introduce the prescribed volume of nutrient solution into the patient’s stomach. The administration is carried out in fractions, 20-30 ml, at intervals of 1-3 minutes.
- After the introduction of each portion, the distal portion of the NGZ is clamped to prevent its emptying.
- After completing formula feeding, it is necessary to introduce the prescribed volume of water into the patient’s stomach. If this is not necessary, the NGZ is washed with saline solution.
End of the procedure
After completing the procedure medical staff performs the following manipulations:
- listens to peristaltic sounds in all parts of the abdomen;
- clean the patient’s mouth and face of contaminants;
- disinfect used materials;
- remove gloves, wash and dry hands;
- ask the patient about his well-being (if he is conscious);
- enter information about the procedure performed and its results in the medical documentation.
Peculiarities
If an infusion pump is used for tube feeding, the operating procedure and settings of the latter are determined by the operating instructions for the device. Utensils and orthopedic products may vary. Premature babies and patients with spinal injuries are fed only in a supine position.
How to reduce the number of complications after nursing procedures
To reduce the number of complications that arise in patients after nursing manipulations, it is necessary to introduce a system for collecting information about post-manipulation complications in medical organizations.
Types of probes
The most accessible and popular option for tube feeding is the nasogastric or nasointestinal route of delivery of nutritional mixtures.
For this purpose, special probes that do not stick to the mucous membrane are used, made of various materials - polyvinyl chloride (PVC), silicone and polyurethane.
PVC probes
The most commonly used probes are made of polyvinyl chloride. It should be taken into account that special materials are used as a PVC softener - diethyl phthalates or polyadipates, which can relatively quickly bind to the fatty component of the introduced nutritional mixtures.
Because of this, the probe loses its elasticity, causes unnecessary trauma to the mucous membranes and increases the risk of bedsores in the nasopharynx.
In addition, during a long stay in the stomach, it can be subject to erosion by hydrochloric acid of gastric juice, as a result of which microcracks and irregularities are formed on its distal part, which can cause mechanical damage to the mucous membrane, including bleeding.
At the same time, phthalates entering the body are toxic, especially for children. The recommended duration of use of PVC probes is no more than 5 days.
Silicone probes
Silicone probes are softer, less traumatic, and have radiopaque tip or olive weights, which greatly facilitates their intestinal insertion and allows radiographic monitoring of their position in the digestive tract. The recommended duration of use of silicone probes is no more than 40 days.
Polyurethane probes
Polyurethane probes contain a radiopaque thread, which allows you to control the location of the probe along its entire length. Their additional advantage is an atraumatic braided conductor with an olive at the end.
Installing such a probe even in a newborn does not cause difficulties or complications. The recommended duration of use of such a probe is no more than 60 days.
Voluntary informed consent of the patient for tube feeding
The patient or his legal representatives must be aware of the upcoming procedure - its nature, duration, and expected effect.
However, written consent for tube feeding is not taken from the patient or his relatives, since the procedure itself does not pose a potential danger to life and health. This is a simple medical service for which voluntary consent is not required.
Manual: nursing manipulations in the treatment room
Download a ready-made manual for nurses: how to carry out nursing manipulations in the treatment room.
See the manual: SOPs and instructions for each procedure. The manual was prepared by experts from the magazine “Chief Nurse”.
Quality control of equipment execution
The nasogastric feeding procedure is considered to be performed correctly and efficiently if:
- there are no signs of trophic disorders and infection along the course of the NGZ;
- there are no deviations from the manipulation algorithm;
- the medical documentation contains a record of the feeding procedure performed;
- the procedure was carried out in a timely manner;
- the patient is satisfied with the quality of the medical service provided.
How to develop a system of criteria for evaluating the performance of nurses
To formulate criteria for assessing quality nursing activities, use the Shewhart-Deming process approach methodology (PDCA method).
Imagine the interaction between the patient and medical worker as a dynamic process.
First of all, you need to evaluate the nursing care performed on the patient. medical services in terms of their timeliness and correctness; secondly, compliance with the requirements for organizing circulation medicines, medical products and SanPiNov.
Practical recommendations for drawing up criteria for evaluating the work of nurses. Develop your own system of criteria that will be effective in your medical organization and convenient for you in the journal “Chief Nurse”.
Insertion of a nasogastric tube (NGT)
Before inserting a nasogastric tube into the patient’s stomach, you need to prepare the appropriate equipment:
- a gastric tube with a diameter of 0.5-0.8 mm (it should be placed in the freezer an hour and a half before feeding - this is necessary so that it becomes more rigid);
- glycerin or sterile petroleum jelly;
- cup clean water with a drinking straw;
- Janet syringe with a capacity of 20 ml;
- adhesive plaster;
- probe plug;
- scissors;
- clamp;
- tray;
- napkins;
- towel;
- gloves;
- safety pin.
Algorithm:
- If the patient is conscious, ask him whether he understands what procedure is ahead of him and how it will be carried out, and obtain his verbal consent to carry out feeding. If the patient is not aware of the tube feeding procedure, clarify further actions from the attending physician.
- Determine the half of the nose that is best suited for insertion of the probe:
- close one nostril first, ask the patient to breathe with his mouth closed;
- repeat these manipulations with the second nostril.
- Calculate the distance to which the NGZ needs to be introduced.
- Help the patient take a high Fowler position, cover his chest with a towel or large napkin.
- Clean your hands and put on medical gloves.
- Lubricate the blind end of the probe with glycerin or petroleum jelly.
- Ask the patient to tilt his head back slightly.
- Insert the probe through the nasal passage 15-18 cm, ask the patient to tilt his head forward.
- Carefully advance the probe into the pharynx along back wall, encourage the patient to swallow, if possible.
- As soon as the tube is swallowed, make sure that the patient feels well and can breathe and speak freely.
- Gently advance the NGZ along the esophagus to the desired level.
- If the patient is able to swallow:
- give him a glass of water with a drinking straw, ask him to drink in small sips, pushing the probe (you can add a little ice to the water);
- make sure that nothing interferes with the patient’s breathing and speech;
- Carefully advance the probe to the desired mark.
- Help the patient swallow the tube by gently pushing it through each swallowing movement.
- Check correct position NGZ in the stomach:
- using a 20 ml syringe connected to a probe, introduce air into the stomach while auscultating the epigastric area;
- connect the syringe to the probe, aspirate a small amount of stomach contents (water and gastric juice).
- If you need to leave the probe for a long time, it must be secured with adhesive tape.
- Close the probe with a plug and attach it to the patient’s clothing with a safe pin.
- Remove gloves, wash and dry hands.
- Help the patient take a position that is comfortable for him.
- Add to medical documents patient information about the procedure performed and reactions to it.
- The probe is washed with saline every 4 hours.
Probe care
Caring for NGZ left on for a long time, is similar to caring for a catheter inserted into the nose for oxygen therapy. It is changed every 2-3 weeks. To feed patients, crushed food, special balanced nutritional mixtures, dairy products, broths, tea, butter, etc. are used.
The total one-time food volume is 0.5-1 l.
The probe may become clogged with a blood clot, piece of food, or tissue fragments, so it must be rinsed with saline solution. Rinsing with water is not recommended, as this can disrupt the electrolyte balance.
Target: Artificial feeding of the patient.
Equipment: Sterile gastric tube, 0.5-0.8 cm in diameter, sterile glycerin, a glass of water 30-50 ml. and drinking tube, Janet syringe 60 ml, adhesive plaster 1 × 10 cm, clip, scissors, probe plug, stethoscope, safety pin, tray, towel, napkins, clean gloves.
| Stages | Rationale |
| 1. Explain to the patient the process and essence of the procedure and obtain the patient’s consent. | Patient motivation to cooperate. Respect for patient rights. |
| 2. Prepare equipment. | Providing fast and effective implementation procedures. |
| 3. Determine the appropriate method of inserting the probe: first press one wing of the nose and ask the patient to breathe, then repeat these actions with the other wing of the nose. | The procedure allows you to determine the most passable half of the nose. |
| 4.Determine the distance to which the probe should be inserted (from the tip of the nose to the earlobe and down the front abdominal wall below the xiphoid process (height -100 cm) | Will allow you to implement correct technique insertion of the probe. |
| 5.Help the patient assume a high Fowler's position. | A physiological position is created when swallowing. |
| 6.Cover the patient’s chest with a towel. | Protecting clothing from contamination. Ensuring infection safety |
| 7.Wash and dry your hands. Wear gloves. | Ensuring infection safety |
| 7. Moisten the blind end of the probe with water or glycerin. | Ensuring the insertion of a probe, preventing nasal injuries and discomfort. |
| 9.Have the patient tilt his head back slightly. | Provides the ability to quickly insert the probe. |
| 10.Insert the probe through the lower nasal passage at a distance of 15-18 cm. | The natural curves of the nasal passage make it easier to pass the probe. |
| 11.Ask the patient to straighten his head to a natural position. | Provides the possibility of further insertion of the probe. |
| 12.Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add a piece of ice to the water. | Facilitates the passage of the probe through the oropharynx, reduces friction of the mucous membrane. During swallowing, the epiglottis closes the “entrance” to the trachea, while simultaneously opening the entrance to the esophagus. Cold water reduces the risk of nausea. |
| 13. Help the patient swallow the probe, pushing it into the pharynx during each swallowing movement. | Discomfort is reduced. |
| 14.Ensure that the patient can speak and breathe clearly. | This ensures that the probe is in the esophagus. |
| 15. Gently advance the probe to the desired mark. If the patient is able to swallow, offer him or her to drink water through a straw. As the patient swallows, gently advance the probe. | Facilitates probe advancement. |
| 16. Make sure that the probe is located correctly in the stomach: inject about 20 ml of air using a Janet syringe, listening to the epigastric region, or attach the syringe to the probe and during aspiration the contents of the stomach (water and gastric juice) should flow into the probe. | Provides the possibility of carrying out the procedure. The correct position of the probe is confirmed. |
| 17. If necessary, leave the probe on long time: cut the patch 10 cm long, cut it in half 5 cm long. Attach the uncut part of the adhesive plaster to the probe and secure the strips crosswise on the back of the nose, avoiding pressing on the wings of the nose. | Probe displacement is avoided. |
| 18. Close the probe with a plug (if the procedure for which the probe was inserted will be performed later) and attach it with a safety pin to the patient’s clothing on the chest. | The leakage of gastric contents between feedings is prevented. |
| 19. Help the patient take a comfortable position. | Proper body biomechanics is ensured. |
| 20.Remove rubber gloves and immerse them in disinfectant. Wash and dry your hands. | Infectious safety is ensured |
| 21Make a record of the procedure and the patient’s reaction. | Continuity of nursing care is ensured. |
Problem #6
During wrestling, after performing a technique, one of the wrestlers felt sharp pain in the area of the left shoulder joint and shoulder girdle, inability to move in the upper limb.
Objectively: The victim holds the affected limb with his healthy hand, his head is tilted towards the affected shoulder girdle, visually shoulder joint deformed, the integrity of the skin is not broken, on palpation the head humerus defined in armpit. The athlete groans in pain.
You officiate the competition.
Tasks
1.Formulate and justify the presumptive diagnosis.
2.Create an algorithm emergency care to the victim, justify your answer.
3. Demonstrate immobilization of the limb in relation to this situation (in different ways).
