What is a nasogastric tube introduction
What is a feeding tube?
A nasogastric tube is a plastic tube that is inserted into the patient's stomach through the nose or, more rarely, through the mouth. The tube is about a meter long and a few millimeters in diameter and is hollow on the inside. The end is attached to a clear plastic bag outside the body, which collects gastric juice that flows back. Water, medication or liquid food can be fed into the stomach through a second opening.
A special probe is the so-called jejunal probe. This ends in the jejunum, a section of the small intestine. The tube of such a probe often also contains several openings, which open into the stomach and small intestine, for example, and enable precisely controlled artificial nutrition.
When do you need a nasogastric tube?
A doctor needs to put a nasogastric tube in for a variety of reasons. Often patients are no longer able to ingest or swallow food independently. As soon as they have basically consented to such artificial feeding, patients therefore need a nasogastric tube in the following cases:
- After a stroke
- For swallowing disorders due to nerve damage or cancer
- During intensive care treatment
A nasogastric tube is not suitable for permanent artificial feeding, as the tube is very cumbersome in everyday life. If it becomes apparent that a patient needs to be artificially fed for a longer period of time, a gastric tube is used, which is placed directly through the epigastric skin as part of a gastroscopy (percutaneous endoscopic gastrostomy, PEG).
Gastric tube as an examination
The doctor can also perform medical examinations with the help of a nasogastric tube. For example, it detects gastric bleeding when blood flows back into the bag. In the case of gastric mucosal inflammation, doctors also examine the gastric juice for certain pathogens. Swallowing disorders or mobility disorders of the esophagus are also diagnosed with the help of special pressure gauges in a gastric tube.
Decrease in stomach pressure
With some diseases there is a risk that the patient will choke on rising gastric juice. The stomach acid damages the lung tissue. This is the case, for example, with an intestinal obstruction, gastrointestinal movement disorders after an operation or with persistent vomiting. Even patients who have eaten or drunk shortly before an emergency general anesthetic, the doctor must insert a nasogastric tube to reduce the risk of gastric juice flowing back.
What do you do when placing a nasogastric tube?
A doctor can put a nasogastric tube in both an awake patient and an anesthetized patient. An anesthetic is sprayed into the nose and throat in order to insert the tube painlessly and to exclude sneezing and gagging stimuli. So that it glides better, the probe is coated with a gel.
To make gliding easier, the patient leans their head back and the doctor pushes the tube towards the throat. If the tube is in the throat, the patient drinks a few small sips of water and the doctor pushes the tube further in.
Finally, the doctor checks the correct position of the probe by forcing air from a syringe into the tube and listening to the stomach with the stethoscope. If he does not hear a "bubbling" there, an X-ray must be taken for control. Finally, the nasogastric tube is attached to the nose and cheek with a plaster strip.
Remove gastric tube
If the nasogastric tube is no longer necessary, the plasters are loosened and the tube pulled out. Patients feel no pain here, occasionally a gag reflex and an unpleasant taste arise.
What are the risks of a nasogastric tube?
The plastic tube can damage the sensitive lining of the nose, throat or esophagus. Bleeding that occurs can lead to complications, especially in patients with coagulation disorders.
Due to the curvature of the tube, a loop can form when it is pushed forward and the gastric tube tangle. Withdrawal is then no longer possible, which is why the doctor has to remove the gastric tube during a gastroscopy. A wound gastric tube increases the risk of gastric juice backflowing, and nausea and malaise also occur.
Clogging of the probe
If the probe becomes clogged, it must be rinsed with plenty of clean water. If this is not enough, the doctor will insert a new gastric tube with a larger diameter.
In sleeping patients, for example in an intensive care unit, there is a risk of pressure sores if the tube is fixed too tightly. The nasal mucous membrane in particular is at risk here. If such damage is not recognized in time, the surrounding tissue can become inflamed.
What do I have to consider with a nasogastric tube?
Even if you may find the insertion uncomfortable, a nasogastric tube is usually barely noticeable. However, if you feel persistent gagging or nausea or pain in the nasal mucosa, you should speak to your doctor about this. Also make sure that the hose is the Nasogastric tube is not accidentally pulled out.
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