Gastric sounding, technique. What is a nasogastric tube? We get acquainted with the technique of introduction and features of feeding Setting up a gastric tube algorithm

Nasogastric tube (feeding probe)- is the ideal solution for enteral nutrition of patients who cannot eat independently and the introduction of medicines. The enteral feeding tube is excellent for nasal insertion, it is inserted through the mouth or nose and enteral nutrition is delivered through it.

Buy a nasogastric tube (nutrition tube):

Quality standards:GOST R ISO 10555.1-99, GOST R ISO 10555.2-99, GOST R ISO 10993 (parts 1,2,5,10), GOST R 52770-2007

Nasogastric tube setting algorithm:

Lubricate the probe tip before starting work.
Enter through the mouth or nose, after the introduction, make sure that the probe is in the stomach (small intestine).
The enteral feeding tube can be used for three weeks without loss of properties.

Nutrient nasogastric tube scheme

A - probe body;
B - cannula;
C - cap;
D - marks;
E - rounded atraumatic end;
F - lateral holes.

Nutrient nasogastric tube Apexmed

It is made of transparent polyvinylchloride implantation-non-toxic. The Apexmed nutrient probe has an atraumatic terminal end and a radiopaque line.

Tags location:

Length 1200 mm:

Length 400 mm: 150 mm, 160 mm, 170 mm from the distal end.

Sterilization: ethylene oxide.

Disposable.

Shelf life: 5 years

Instructions for use:

• measure the distance from the tip of the nose to the earlobe, mark this distance on the probe (1st mark);
• measure the distance from the incisors to the navel plus the width of the patient's palm, mark on the probe (2nd mark - "entrance to the stomach");
• lubricate the probe with sterile glycerin or sterile vaseline oil;
• insert the probe through the nasal passage, first at a distance of up to 1 mark;
• then, making sure that the probe is at the root of the tongue, continue inserting the probe up to the 2nd mark;
• make sure that the probe is in the stomach (auscultation of the epigastric region after introducing 20 ml of air into the stomach through the probe);
• fix the free end of the probe on the patient's cheek with an adhesive plaster or a special kit;
• connect a syringe or enteral feeding system with a nutrient mixture to the cannula of the probe;
• at the end of feeding, rinse the probe with 30-50 ml of water;
• before the next introduction of the nutrient mixture, close the end of the probe with a special plug, attach with a plaster on the cheek;
• remove the probe through a napkin moistened with disinfectant;
• process and dispose of the probe in the prescribed manner.

Manufacturer: Apexmed International B.V., Netherlands (Apeksmed)

The feeding nasogastric probe Integral is made of transparent implantation-non-toxic polyvinyl chloride. The material is thermoplastic and softens under the influence of the temperature of the surrounding tissues. A radiopaque line is built into the wall of the probe along its entire length. The special arrangement of the side holes, which significantly reduces the risk of developing "dumping" syndrome. When twisting the nasogastric tube, the lumen does not overlap. Luer type connector adapted for use with automatic dosing devices. Equipping the connector with a hermetically sealed plug prevents fluid from leaking out and preventing contamination of the contents of the catheter.

Tags location:

Length 1200 mm (Ch/Fr 4-18): 500 mm, 600 mm, 700 mm, 800 mm, 900 mm from the distal end;

Length 1000 mm (Ch/Fr 4-18): 450 mm, 550 mm, 650 mm, 750 mm, 900 mm from the distal end;

Length 400 mm (Ch/Fr 4-10): 140 mm, 150 mm, 200 mm from the distal end.

The closed distal end of the probe is carefully machined and rounded for atraumatic placement.

Sterilization: ethylene oxide (EO)
Best before date: 3 years

Manufacturer:

"INTEGRAL Medical", China
"Hayan", China

Nutrient nasogastric tube TRO-NUTRICATH and children's (pediatric) TRO-NUTRICATH paed

Nasogastric feeding tube for children TRO-NUTRICATH paed - is a hollow tube equipped with a soldered Nelaton-type tip with two side holes and a connector for connecting to dosing devices. The nasogastric tube is designed for enteral nutrition and the introduction of drugs into the stomach cavity. Can be used in neonatology, pediatrics and adult patients.

Features and benefits of the TRO-NUTRICATH probe and TRO-NUTRICATH paed:

Made of neutral polyvinyl chloride (PVC), which allows you to use the probe for three weeks without deterioration of their properties, without allergic reactions;
- rounded, soft end of the probe ensures easy, atraumatic and painless insertion. - the presence of side holes at the end, contributes to the most complete intake of nutrient mixtures, drug solutions into the stomach, sufficient drainage of the stomach and reduces the risk of dumping syndrome;
- the connector is equipped with a hermetically sealed stopper that prevents liquid from flowing out and prevents infection of the contents of the probe;
- the probe connector has an adapter, due to which the nasogastric tube is compatible with devices of two types of connection: Luer and Catheter-type (with syringes of standard volumes, syringes of large volumes, automatic dosing devices);
- a radiopaque strip along the entire length, and marks every 10 cm, make it easier to determine the position of the catheter in the gastrointestinal tract;
- the connector is color-coded depending on the size of the nasogastric tube (according to ISO standards), which makes it easy and quick to select the required size;
- Size range:
NUTRICATH paed - 4-10 Fr (length 50 cm)
NUTRICATH - 6-24 Fr (length 105 cm);
- sterile individual blister packaging (paper + polyethylene film).

Best before date: 5 years

Navigation

Throughout life, a person may encounter certain diseases and various health problems, some of them so serious that they can disrupt certain functions of the body. One of these problems is a violation of the swallowing function, in which a person loses the ability to eat independently in the traditional way.

There is a way out of such situations - the installation of a nasogastric tube, that is, a special device that eliminates the need for chewing and swallowing functions.

This type of food can be used long time, it is applicable both in hospital and at home, allowing you to provide the patient with all the necessary nutrients.

What is a feeding tube?

As already mentioned, the phrase "feeding tube" means a special device that is introduced into the human body through the nasal passage, nasopharynx and esophagus directly into the stomach, such a tube is also called a nasogastric tube.

The device of this device is simple, it consists of a long hollow tube, rounded at one end, which prevents damage internal organs and fabrics. This tube has a small diameter, it is made of completely hypoallergenic materials, which eliminates any threat to the health of the patient. In addition, the material from which the probes are made is very elastic, and when it comes into contact with a humid and warm environment human body becomes more plastic.

On the outer side of the probe, the tube is equipped with a special funnel-shaped hole through which it introduces liquids (using a Janet syringe and specially prepared food).

Syringe jane

This hole is covered with a special cap, which prevents even the smallest foreign particles or objects from getting inside.

It is also important to understand that depending on the age of the person, the specifics of his problem and physiological factors, the feeding tube may differ slightly, the length of the tube varies, as well as its diameter. This allows the device to be used even for infants, and not only in the case of adult patients.

Indications for the use of the probe

Tube feeding is carried out in cases where a person, for some reason, is unable to chew or swallow food on his own. In this case, we are talking about physiological abnormalities, injuries, pathological conditions bodies oral cavity and throat, as well as psychological deviations and disorders of the nervous system.

If we talk about the need to use this device in more detail, it is used in the following situations:

• After a stroke, we are talking about cases where there is damage to the parts of the brain that control the muscle groups responsible for the function of swallowing. This may be a complete or partial violation, in such cases, enteral nutrition is carried out until the patient undergoes a course of rehabilitation. With a stroke, if the nature of the damage is severe, and the person is advanced in age, there is a risk of permanent use of the probe.
• Physical injuries - severe head injuries that provoke a swallowing disorder, edematous conditions of the tongue, pharynx, larynx and esophagus. This also includes injuries of the indicated departments and organs, in which their integrity is violated.
• Coma and other manifestations of unconsciousness also require tube feeding.
• Psychological abnormalities, illnesses and certain forms mental disorder accompanied by a person's refusal to eat.
• Neurological diseases, among which the most severe are Parkinson's, Alzheimer's or severe forms multiple sclerosis with corresponding disorders and indications for tube feeding.
• Special medical indications, if any surgical intervention concerning some organs of the gastrointestinal tract, for example, resection of the stomach.
• The installation of a probe through the nasal passages for subsequent enteral feeding is also carried out for children with certain forms of prematurity, if the baby does not have sucking and swallowing reflexes.

In each of the points described, a full-fledged traditional diet is either completely impossible or undesirable, as it can harm the patient, causing not only choking, but also infection of damaged areas of internal organs and soft tissues, food entering the respiratory tract.

In what other cases is a probe installed?

In addition to the indications mentioned, you need to know that the device under discussion is installed not only for feeding, it can also be used for other purposes:

1. The implementation of the introduction of some medicines, mainly those that are taken orally, but there is no possibility for this;
2. Decompression of the stomach, that is, a decrease in internal pressure inside the organ in cases where its contents, for some reason, are unable to freely enter the intestine, for example, in case of obstruction of the latter;
3. Aspiration of the stomach - "pumping out" of the gastric contents, as well as particles in duodenum. This procedure is often performed in preparation of the patient for surgery.

Contraindications for the introduction of the probe

The list of indications for providing assistance to patients with probing is wide, as you can see, the probe is used not only to provide a sick person with food or medicine. However, there are contraindications for such a procedure. Of course, their list is not so extensive, but still they are:

• Facial injuries with significant damage to the bones of the facial skeleton, preventing the installation of a nasogastric tube, or making it difficult to breathe when it is installed;
• All kinds of blood clotting disorders of varying severity, especially hemophilia;
• Aggravation peptic ulcer stomach;
• Varicose veins in the esophagus;
• Narrowing of the lumen or body of the esophagus, preventing the passage of the probe tube.

Probe installation process

The process of installing a nasogastric tube consists of a number of clear and well-established steps. The main requirement for its correct installation is that the patient is conscious, first he needs to explain the whole process.

The fact is that in an unconscious state, the risk that the tube instead of the esophagus enters the respiratory tract increases, so that this does not happen, the doctor must insert two fingers into the patient's throat, contributing to the correct passage of the probe tube. If a person is conscious, at the moment of passing through the body of the device, he must make a swallowing movement.

Installation - the process is not too complicated, but in the case of installing a nasogastric tube at home, it is better if a specialist takes care of this. In general, the process takes place in several stages.

Training

It consists in preparing everything you need (a probe of a certain length and diameter, a Janet syringe with a volume of 150 to 200 milliliters, several clamps, a marker, an anesthetic, glycerin or lidocaine). It is also necessary to explain to the person the upcoming procedure, if he is conscious.

Installation

Before starting the installation, it is recommended to place the device used in the refrigerator in order to stiffen the tube, which will contribute to its easier passage. In addition, the cold body of the tube will reduce the gag reflex.

It is also necessary to first disinfect the hands, and the patient, even if it concerns a bedridden patient, should be given a sitting or half-sitting body position.

The next course of action is:

1. Check the patency of the nostril for insertion. To do this, each nostril is alternately clamped and performed respiratory movements, in some cases it is necessary to clear the nose;
2. Several marks are made on the probe. First, the distance from the earlobe to the mouth, then, from the oral cavity to the xiphoid process of the sternum. The first segment speaks of reaching the larynx, the second shows the length by which the tube must be placed inside;
3. To reduce the gag reflex and eliminate discomfort, the nasal cavity and pharynx are treated with lidocaine;
4. The end of the probe, which will be placed in the human body, is lubricated with the same lidocaine or glycerin, which ensures its easy and unhindered advancement;
5. Through the nasal passage, the tube is brought to the larynx (1 mark), after which the person must make swallowing movements, contributing to its further advancement;
6. As soon as the advancement of the device reaches the second mark, the probe is in the stomach, further movement stops;
7. Now you need to check the correct position of the tube. To do this, a syringe is taken and up to 30 milliliters of warm boiled water is injected through the upper funnel. If while listening abdominal cavity a certain semblance of “gurgling” is heard, everything is done correctly;
8. The funnel at the outer end of the probe must be covered with a cap, and the end itself must be fixed by fastening it with a pin to the collar or gluing it with a plaster.

Installing a feeding device is not so difficult, however, you need to act clearly, confidently and correctly. If you are not confident in your abilities, it is better to seek help from a specialist. Detailed instructions with a video explanation of the installation process of the device you will find in the section

Features of feeding

If the probe is installed, and the patient feels fine, you can start eating. It is important to understand that the feeding of the patient through the probe must be carried out with dishes only in a liquid state, while they must be warm.

Probe nutrition is carried out gradually, the first 2-3 servings should not exceed 100 milliliters at a time. Then gradually the volumes can be increased, eventually reaching up to 300 milliliters.

All enteral formulas are prepared separately, but this can be done at home. Among the products used, the following are especially good:

• Kefir;
• Fish, meat and boiled broths;
• Thoroughly ground and diluted mashed potatoes from the same products;
• Rare semolina porridge with milk;
• Specialized mixture for tube feeding and more.

A number of products are dangerous to give to a patient with dysphagia, as they can get into the lungs. From the use of which products it is better to refrain from telling our consultant doctor at.

A patient with a probe is fed at least 3 and no more than 5 times a day, each time using a new sterile syringe.

The diet for the normalization of the patient's stool should be based on dried fruits, vegetables, fermented milk products. On the control of the stool of a bedridden patient.

Nutrition Process

Nutrition for bedridden patients with a probe is also carried out according to a certain scheme, consisting of several points:

1. The patient should take a semi-sitting position;
2. The outer end of the probe falls below the level of the neck and is pinched with a squeeze;
3. A syringe with a nutrient mixture heated to 38-39 degrees is attached to the funnel;
4. The funnel with a syringe is raised to a distance of more than 50 centimeters above the stomach and the clamp is removed;
5. Food is introduced slowly, practically without pressure (150 ml in about 5-6 minutes);

If the patient for a number of reasons cannot take food in the usual way, then special care is needed for his feeding. It is for this purpose that nasogastric tubes for enteral feeding were created. What is it and how do they work, are there any contraindications and difficulties in caring for such product?

Gastric nasogastric tube - what is it?

This is a tube made of implantable non-toxic polyvinyl chloride (PVC), polyurethane or silicone, which is inserted through the nasal passage into the esophagus and then immersed in the stomach. Modern probes are available in various lengths and diameters, for adults and children. Thanks to modern materials that are resistant to hydrochloric acid produced in the stomach, a nutritious nasogastric tube with correct use can be used for 3 weeks.

Most often, such probes are designed for, i.e. for those cases when the patient cannot take food in the usual way. Although sometimes the probe is used for other purposes:

• gastric decompression with difficulty in removing its contents into the intestines,
• aspiration of stomach contents

Nasogastric tube: indications

Why is it impossible to eat normally? There are many diseases and conditions due to which this occurs:

• within complex therapy and pre- or postoperative stage in the treatment intestinal obstruction,
• acute pancreatitis,
• injuries of the tongue, pharynx, abdomen,
• postoperative period after resection of the stomach, intestines, pancreas, suturing of a perforated ulcer, other operations on the organs of the abdominal and thoracic cavities,
• unconscious state (coma),
• mental illness, accompanied by a refusal to eat,
• swallowing disorders due to disorders of nervous regulation (CNS diseases, post-stroke condition),
• fistulas or strictures (narrowing) of the esophagus.

Equipment

1. Sterile gastric tube with a diameter of 0.5 - 0.8 cm.

2. Sterile glycerin.

3. A glass of water 30 - 50 ml and a drinking straw.

4. Janet syringe 60 ml.

5. Adhesive plaster.

7. Scissors.

8. Plug for the probe.

9. Safety pin.

11. Towel.

12. Napkins

13. Gloves.

Preparation for the procedure

14. Explain to the patient the course and essence of the upcoming procedure and obtain the patient's consent to the procedure.

15. Wash and dry your hands.

16. Prepare the equipment (the probe must be in the freezer 1.5 hours before the start of the procedure).

17. Determine the distance to which the probe should be inserted (the distance from the tip of the nose to the earlobe and down the front abdominal wall so that the last opening of the probe is below the xiphoid process).

18. Help the patient to accept the high position of Fowler.

19. Cover the patient's chest with a towel.

20. Wash and dry your hands. Put on gloves.

Performing a procedure

21. Copiously treat the blind end of the probe with glycerin.

22. Ask the patient to tilt his head back slightly.

23. Insert the probe through the lower nasal passage at a distance of 15–18 cm.

24. Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add ice cubes to the water.

25. Help the patient to swallow the probe, moving it into the throat during each swallowing movement.

26. Make sure the patient can speak clearly and breathe freely.

27. Gently advance the probe to the desired mark.

28. Make sure the probe is in the correct location in the stomach: attach the syringe to the probe and pull the plunger towards you; the contents of the stomach (water and gastric juice) must enter the syringe.

29. If necessary, leave the probe for a long time, fix it with a patch to the nose. Remove towel.

30. Close the probe with a plug and attach with a safety pin to the patient's chest clothing.

Completion of the procedure

31. Remove gloves.

32. Help the patient to take a comfortable position.

33. Place the used material in a disinfectant solution for subsequent disposal.

34. Wash and dry your hands.

35. Make a record of the procedure and the patient's response.

It is necessary to monitor the patency of the probe. Periodically wash the probe with saline (30-50 ml) or slightly change its position. After operations on the esophagus and stomach, these activities are carried out with extreme caution.

9. Elastic bandaging of the lower extremities

List of medical products and equipment:

1. Elastic bandage 5 meters - 2 pcs

Description of the execution algorithm:

Explain to the patient about the purpose of the upcoming manipulation

Take the correct position in relation to the patient (on the side of the patient).

Lay the patient on his back (Install the mannequin correctly in a horizontal position).

Determine the indications for elastic bandaging (varicose veins of the lower extremities, soft tissue bruises and sprains) - list the characteristic clinical symptoms

Determine contraindications for applying elastic bandages.

Give the characteristics of the bandage: soft, elastic.

Give the correct position to the bandaged limb (raise the limb by 45-46 degrees from the couch.

Get the bandage right. (The beginning of the film or bandage is held in the left hand, the head of the wrapping material in the right).

Roll out the material (elastic bandage) on the bandaged limb (from left to right with the back on the surface to be wrapped, without taking your hands off it and without stretching the material in the air, bandaging from the bottom up).

Fixation of the last round of the elastic bandage with metal staples.

Criteria for the correct application of an elastic bandage: the limb is physiologically colored, warm, pulsation is preserved

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Probe placement technique, probe diets

Nasogastric tube

2. Contraindications:

b) head injury possible fracture base of the skull.

3. Anesthesia. Topical aerosolized 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 of ice.
5. Position: sitting or lying on your back.

6. Technique.

6.2. Some anesthesiologists place the tip of the probe in an ice cup to harden it or bend it. This maneuver facilitates easier passage of the tube into the proximal esophagus.

6.3. Lubricate the tube with petroleum jelly (glycerin).

6.4. Ask the patient (if conscious) to bend 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 portion of the tube has been swallowed, ensure that the patient is able to speak and breathe freely without difficulty. Move the tube gently to the set distance. If the patient can, ask him to drink water through a regular straw, passing the probe in parallel during the sip.

6.7. Proper placement of the probe is confirmed by injecting approximately 20 ml of air through the probe using a syringe. In parallel, performing auscultation in the epigastric region.

6.8. Secure the tube gently to the patient's nose with a patch. The tube must be constantly lubricated to prevent erosion of the nasal mucosa. With a patch or pin, the tube can also be secured to the patient's underwear.

6.9. Every 4 hours, the tube should be flushed with 30 ml of saline.

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 to be kept below pH 4.5.

6.12. The nature of the secreted contents of the stomach should be controlled, especially when performing enteral nutrition. It is preferable to use a plain chest x-ray to confirm the correct position of the tube before using it for enteral feeding.

6.13. Ideally, the tube should not be blocked by the clamp. The probe keeps the esophageal lumen open at all times, 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, associated with the large diameter of the probe used, can be relieved by a sip of water. Aerosolized pharyngeal anesthetics should be avoided as they may inhibit the reflex that is essential for protection. respiratory tract.

7.2. Erosion of the nasal mucosa. This complication can be prevented by keeping the tube constantly lubricated and by 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. Frequent checks for correct tube position can help prevent this problem.

7.3 Sinusitis. Occurs with prolonged use of a nasogastric tube and requires removal of the tube and its placement through another nasal passage. Antibiotic therapy is needed.

7.4. Nasotracheal intubation (erroneous placement of the probe into the airways). It leads to airway obstruction and is diagnosed quite easily in patients who are normally conscious (cough, unable to speak). Proper placement of the probe requires a chest x-ray.

7.5. Gastritis. It usually manifests itself as a slight, self-limiting, gastrointestinal bleeding. Prevention of this complication consists of maintaining the gastric pH below 4.5 with antacids given by tube, IV H2 receptor blockers given, and, if possible, early removal of the tube.

7.6. Epistaxis (nosebleed). Usually docked on its own. If bleeding continues, remove the tube and determine the site of bleeding. Treatment of epistaxis requires tamponade of the nasal passage.

Orogastric tube

1. Indications: enteral nutrition in disorders of consciousness and dysphagia.

2. Contraindications:
a) recent surgery of the stomach or esophagus;
b) head trauma with a possible fracture of the base of the skull.

3. Anesthesia. Topical 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 the back.

6. Technique:
6.1. Measure the tube from the mouth to the eyebrow and down to the anterior wall of the abdomen so that the last opening of the probe is below the xiphoid process. This indicates the distance over which the tube must be inserted.

6.2. Lubricate the tube with petroleum jelly (glycerin).

6.3. Since patients undergoing orogastric intubation are usually unable to assist during the procedure, the tube should be placed in the mouth, pointing backwards 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 terminated and the tube removed. Repeat step 6.3 again. If the tube advances easily with minimal resistance, continue swiping the previously measured distance. The presence of resistance or coiling of the tube, or hypoxia, is indicative of improper placement of the tube in the trachea.

6.5. Proper placement of the probe is confirmed by injecting approximately 20 ml of air through the probe using a syringe, while simultaneously performing auscultation in the epigastric region. Also, the 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.

6.7. Depending on the type of probe and its purpose, aspiration from the tube is carried out periodically or continuously.

6.8. The nature of the secreted contents of the stomach should be controlled, especially if used for enteral nutrition. A plain chest x-ray is necessary to confirm the correct position of the tube before using it for enteral feeding.

6.9. Gastric pH should be monitored every 4 to 6 hours and adjusted with antacids to keep it below pH 4.5.

7. Complications and their treatment.

7.1. Unpleasant sensations in the throat may occur in patients who are conscious, therefore this species they do not use intubation, except for patients on mechanical ventilation.

7.2. Tracheal intubation. Proper placement of the probe is confirmed by its easy passage into the esophagus. Any resistance indicates that the tube has entered the trachea or is coiled in the back of the throat. Proper placement of the probe requires a chest x-ray.

7.3. Gastritis. It usually manifests itself as a slight, self-limiting, gastrointestinal bleeding. Prevention of this complication consists of maintaining the gastric pH below 4.5 with antacids given by tube, IV H2 receptor blockers given, and, if possible, early removal of the tube.

A.P. Grigorenko, Zh.Yu. Chefranova