Nasogastric tube
In medicine, a stomach tube is a tube that is pushed through the mouth or nose along the natural upper digestive tract, i.e. through the throat and esophagus to the stomach . This differs from the PEG tube that is placed through the abdominal wall. In veterinary medicine is the nasogastric tube inserted, which is pushed through the nose into the esophagus, in horses and into the stomach.
Indications
A nasogastric tube is indicated whenever there is a disruption of the oral supply of food, fluids and medication, e.g. B. in swallowing disorders or because of wiring between the upper and lower jaw after a surgical procedure . Occasionally, they are used to artificially feed hunger strikers or anorexic people against their will . Another indication is the derivation of stomach contents, for example before, during or after operations on the abdominal cavity, in the case of intestinal obstruction (ileus) or after oral ingestion of poisons (alcohol, tablets, thinners, acids ...). In addition, gastric juice can be obtained through a gastric tube for diagnostic purposes. It can also be used to stabilize, expose or splint the esophagus during operations.
A feeding tube is usually relatively easy to insert and more suitable for short-term applications (up to two weeks). Placing and maintaining ( changing bandages ) a gastric tube through the abdominal wall as a percutaneous endoscopic gastrostomy (PEG tube) is more time-consuming.
Long-lying gastric tubes can be fitted with a special "nasal olive" made of silicone, which is adapted to the patient's nose by means of an impression process and lies inside the nostril. In this way, the nasogastric tube can be "sunk" when not in use. Due to the extensive invisibility, the compliance or adherence of the patient can be improved and thus possibly the nutritional situation as well.
Contraindications
A nasogastric tube should not be inserted in the case of major injuries, fractures or tumors in the area of the mouth and throat or the esophagus. Varicose veins in the esophagus ( esophageal varices ) or chemical burns to the esophagus are also contraindications. Further exclusion criteria for nasal tubes are infections of the paranasal sinuses and severe coagulation disorders .
Inserting a nasogastric tube
Basics
Despite possible complications, the placement of a nasogastric tube is generally unproblematic. Serious complications from the system are rare.
The feeding tube can be placed through the nose or through the mouth, preference being given to placing it over the nose. A lubricant is usually applied. The head is tilted slightly forward and the awake patient is asked to swallow. In the case of unconscious or sedated patients, the probe can be guided with the fingers; in difficult situations, a laryngoscope and Magill forceps may be necessary.
The position can be checked by passing around 50 ml of air through it, if a typical gurgling noise can be heard in the stomach area with the stethoscope, and then the same amount of air and some gastric juice can be drawn in. If in doubt, the position must be checked radiographically. Then the probe is secured tension-free with a plaster on the bridge of the nose.
used material
Gastric tubes are made from different materials. Mostly it is polyvinyl chloride (PVC), polyurethane or silicone . Most probes can be shown radiologically. PVC probes have a shelf life of three days, as the plasticizers they contain dissolve from the material within a few days and the probes become rigid. Polyurethane and silicone probes can be used for up to six weeks. The soft material does not lose any plasticizers and is friendly to the esophagus and mucous membranes. Silicone probes have a thick wall and narrow lumen , gastric probes made of polyurethane have a thin wall and wide lumen.
A distinction is also made according to size, length (100–130 cm) and number of lumens (2–3 can probe different locations). The most common sizes are: CH 6-8 for newborns, CH 8-10 for toddlers, CH 10-12 for children, CH 12-18 for adults.
Complications in the installation
During the application, vomiting can occur by triggering the gag reflex or nosebleeds when the probe is inserted through the nose. Injuries, ie perforation of the nasal mucosa, throat, bronchi or esophagus , are rare. In individual cases a breakthrough through the skull bone and thus the intracranial position of the gastric tube has occurred. Triggering vagal reflexes can cause bradycardia or, in extremely rare cases, cardiac arrest . Likewise, the heart rate can increase when the feeding tube is inserted because the uncomfortable feeling causes stress.
Complications
The probe can slip out (dislocation) if it is accidentally pulled (e.g. when moving the patient). This can also happen if you cough or vomit. If the fixation of the tube to the nose or mouth remains undamaged, the gastric tube may have wound up in the throat or moved into the windpipe. If this is not noticed and the position of the tube is not checked before food or liquid is administered, tube food administered does not get into the stomach, but into the throat or trachea, with correspondingly life-threatening consequences. A ( aspiration ) can occur when the patient is administered the food or other contents of the stomach unnoticed regurgitated and do not have sufficient protective reflexes (swallowing, gagging, cough reflex) has. This can cause pneumonia .
The lying gastric tube promotes infections of the paranasal sinuses (sinusitis). By prolonged hospital stay may cause pressure sores ( ulcers ) or decubitus come to the nostrils, nasal, throat, esophagus and stomach.
Upkeep and maintenance
Normal food can be administered through the tube, provided it is liquid enough. In today's medical environment, however, almost exclusively industrially manufactured liquid food (is tube feeding ) is used. Almost every dietary composition can be found on the list of the respective manufacturers.
Before each administration of liquid or food, a position check must be carried out to ensure that the tube has not slipped into the windpipe . The probe position must also be checked once per shift. After administration, the nasogastric tube is usually rinsed with 50 to 100 ml of clear water. With the gastric tube lying down, an extensive nasal care should be carried out at least once a day.
If the gastric tube is used to drain secretion, the collection bag must be changed or emptied daily or as required. The volume is measured and logged. The collection bag must be fixed below the stomach level in such a way that there is no tension on the probe and the secretion can drain off easily.
Longer feeding tubes: duodenal and jejunal tubes
Depending on the length, the probe can end in the stomach (gastric), in the duodenum (duodenal), or in the empty intestine (jejunal). With double-barreled probes, the lumina usually end in different places, so that they come to lie in two different sections (e.g. one opening in the stomach, the other in the duodenum).
For example, a jejunal probe can be placed using an endoscope or electromagnetic positioning systems. The jejunal probe position is checked with a sample on litmus paper (pH greater than 7), air insufflation or X-rays. When using the jejunal probe, slow, continuous administration (usually via a feeding pump ) is necessary because the jejunum, unlike the stomach, cannot absorb larger volumes at once.
Special features of tube feeding for infants and young children
Under special dependency or -dependenz refers to the unintentional physical and emotional dependence of an infant or small child from an originally planned as a temporary exploratory, but the absence of a medical indication. Permanent feeding through a tube results in a development deficit in the development of the child, which is why its removal often appears to be indispensable.
In the case of infants and toddlers, a tube weaning with training of the chewing and swallowing motor skills is necessary in order to transition to independent feeding .
Individual evidence
- ^ A b c d Hans Walter Striebel: Operative Intensive Care Medicine: Safety in Clinical Practice . Schattauer Verlag, 2008, ISBN 9783794524808 , p. 236.
- ↑ Andreas Hirner, Kuno Weise: Surgery. Georg Thieme Verlag, 2nd edition 2008, ISBN 9783131513229 , p. 113.
- ^ A b c Hugo Karel Van Aken, Konrad Reinhart, Tobias Welte, Markus Weigand: Intensive Care Medicine . Georg Thieme Verlag, 3rd edition 2014, ISBN 9783131511430 , p. 159.
- ^ A. Lauber, P. Schmalstieg: Nursing interventions . Volume 3. Georg Thieme Verlag, 3rd edition 2012, ISBN 9783131515834 , p. 476.
- ^ Hans Walter Striebel: Operative Intensive Care Medicine: Safety in Clinical Practice . Schattauer Verlag, 2008, ISBN 9783794524808 , p. 238.
- ↑ Peter Lawin (Ed.): Practice of intensive treatment . 5th edition. Thieme Verlag, Stuttgart 1989, ISBN 3-13-441805-3 , p. 10, 19 .
- ^ A. Lauber, P. Schmalstieg: Nursing interventions . Volume 3. Georg Thieme Verlag, 3rd edition 2012, ISBN 9783131515834 , p. 479.
- ^ A. Lauber, P. Schmalstieg: Nursing interventions . Volume 3. Georg Thieme Verlag, 3rd edition 2012, ISBN 9783131515834 , p. 476.
- ↑ Susanne Schewior-Popp, Renate Fischer: Examen Pflege , Volume 2, Georg Thieme Verlag, 2007, ISBN 9783131415110 , p. 190.
- ^ A b Hans Walter Striebel: Operative Intensive Care Medicine: Safety in Clinical Practice . Schattauer Verlag, 2008, ISBN 9783794524808 , p. 239.
- ↑ Dunitz-Scheer, M., Huber-Zyringer, A., Kaimbacher, P., Beckenbach, H., Kratky, E., Hauer, A. et al .: Tube weaning . In: Pädiatrie, 4 + 5, 2010, pp. 7–13.
