Nasogastric tube
definition
In medicine, a gastric tube is an apparatus that is used to nourish and supply the patient with fluids. A feeding tube may be needed in two different situations. If your own nutrition is inadequate, it may be necessary to use a gastric tube. In addition, a gastric tube may be used as part of damage caused by illness or surgery. To insert the probe, a plastic tube is pushed through the nose or mouth over the throat and the esophagus into the stomach so that the chyme reaches its destination safely. A thin, liquid chyme containing a lot of calories is usually given through a stomach tube. It should not be used for more than two weeks.
Why do you need that?
The indications for the location of a nasogastric tube are more numerous than one might think. In addition to smaller reasons, two large areas can be defined in which a gastric tube is used. In general, however, a nasogastric tube is used to supply food, fluids and medication. On the one hand, use becomes necessary when the person concerned is no longer able to feed themselves. This can be the case, for example, with a coma, old age and various diseases such as swallowing disorders.
On the other hand, gastric tubes are used when the food passages are blocked due to damage or an operation. It may be impossible to open your mouth after oral surgery. Thus, in an otherwise healthy person, it is the easiest and least harmful method. A gastric tube can also serve as a splint for the chyme during operations in or around the esophagus. This offers greater safety in the event of injuries to the esophagus.
Read more on the topic:
- Diseases of the esophagus
- Narrowing of the esophagus
In addition to these two groups, it is also used in some operations. A gastric tube is often used to suck out gastric juice. This is the case with anesthesia when there is a risk of gastric juice running towards the mouth and reaching the lungs. The contents of the stomach can also be suctioned off in the event of poisoning. Anorexic people or people who are on hunger strike can also be fed this way.
Read more on the topic: Poisoning and chemical burns
anorexia
Anorexia is an eating disorder. The focus here is on weight loss by refusing to eat. On the other hand there is bulimia, where vomiting often occurs after eating. This also occurs because of a mental disorder or an internal compulsion, environmental or family causes and can only be treated with difficulty for some people. In order to be able to treat or minimize the symptoms and their associated risks, artificial feeding by means of a gastric tube is used in very severe and life-threatening cases. This guarantees the best possible nutrition, depending on the circumstances. However, this measure must not be carried out against the patient's will.
Read more on the topic:
- What are the consequences of anorexia?
- How thin can you be?
- Therapy for an eating disorder
How is that laid?
As with any medical procedure, preparation plays an important role in the location of a nasogastric tube. For this, the consent must first be obtained, including a signed declaration of consent.
Next, all the necessary utensils should be laid out. This includes, for example, the probe with length marking, gel, a local anesthetic if necessary, gloves and a stethoscope. In addition, it must be decided whether the tube should be placed through the mouth or through one of the two nostrils. How to proceed depends on whether the procedure is carried out while awake or under general anesthesia. Under general anesthesia, the nasogastric tube can be inserted into one of the openings without any further precautions. If the person is awake, the mouth and throat area must first be locally anesthetized with the help of a spray before introduction. In addition, the probe is smeared with gel, which also causes local anesthesia.
Read more on the topic: Lidocaine spray
After a short period of time, the mouth and throat are numb or poor in feeling, so that no strangling is provoked. Then the tube can be passed through the throat while stretching. The risk of inserting the tube into the windpipe is then reduced by tilting the head. The probe is pushed further up to the previously set length marking. Whether the end of the gastric tube is in the stomach is checked by examining the pharynx. In addition, air can be forced through the hose with a syringe. If the stomach is monitored with the help of a stethoscope, a bubbling will be detected if the position is correct. If this is also not clear, an X-ray is taken.
Then the tube of the nasogastric tube is fixed with adhesive tape in the area of the mouth or the nostrils so that it cannot slip.
Is that painful?
The location of a feeding tube should not in itself be painful. Local or general anesthesia should eliminate all sensations. Sometimes it happens that pushing the feeding tube forward causes an unpleasant gag reflex. Incorrect anesthesia can also lead to slight pain. There may also be minor injuries to the mouth and throat. This can lead to bleeding or pain as soon as the local anesthetic is no longer effective.
Procedure when removing / pulling
Removing a nasogastric tube is generally unproblematic like inserting a nasogastric tube. Here, too, care should be taken to prepare correctly. Since body fluids can reach the body surface, gloves should be put on by the doctor beforehand. Cloths and a kidney dish are also useful. This means that there is no major pollution in the event of vomiting. The wipes can be used to wipe the mouth.
An anesthetic of the mouth and throat area is not necessary when removing. This means that the hose can simply be pulled. This shouldn't be done too quickly. However, if it happens too slowly, the risk of gagging increases. There are usually no injuries.
Complications can only arise if the tube of the probe forms loops. These loops can make it difficult or impossible to remove the probe. However, this problem occurs very rarely and can be solved well.
Whole foods should not be started immediately after removal. It is recommended to first test the full functionality by drinking a clear liquid. If this is successful, an increase in diet can take place.
PEG
The term PEG is used in medicine as an abbreviation for "percutaneous endoscopic gastrostomy". A PEG tube, like a classic gastric tube, is used to supply food, fluids and medication.
However, this probe is not advanced through the mouth or nose and into the stomach. Rather, it is placed with the help of the invasive procedure of endoscopy. To do this, a camera is brought into the stomach through the mouth and a targeted incision is made in the stomach wall. With this cut it is now possible to create a smart through the body surface.
The indications for a PEG tube are similar to those for a normal gastric tube. After operations, constrictions, various illnesses or a coma, the probe should ensure nutrition. It can also be used on people with anorexia. However, the PEG tube is used more frequently compared to the ordinary gastric tube because it is more reliable, especially for constrictions in the esophagus or the mouth and throat.
Overall, however, the installation of a PEG tube represents a major injury, which is why the risks, such as for inflammation, incorrect placement or adhesion, are increased. A few hours after the plant you can eat and drink again. Since such a probe is used for a long time, there is a relatively high risk of adhesion. In order to lower this, the holder is released several times a week and the probe is moved. It also needs to be flushed daily to prevent clogging.
Special features of the baby
A feeding tube is usually used in babies when they do not drink independently for a long period of time. In babies, however, the tube is not inserted through the mouth as often as in adults. Rather, most of the application occurs through one of the two nostrils, which is why the probe is also called a nasogastric tube.
The feeding tube must also be changed more frequently than in adults in order to keep side effects to a minimum. If this does not happen, infections occur more frequently. In general, it should be ensured that a tube is always in place as long as the baby cannot drink independently. Nevertheless, the time a feeding tube is placed is a burden for the child. However, in order to keep this time as short as possible, when changing the tube, an attempt should always be made to see whether the baby can drink. This is important because a stomach tube often prevents the baby from doing it. Through these attempts at changing it is often possible to shorten the duration of the placement of a gastric tube considerably.
Read more on the topic: Reflux in the baby and vomiting in the baby
maintenance
A gastric tube that has already been placed needs special care in order to survive its useful life as long as possible and undamaged. Even if a normal nasogastric tube is not to be used for longer than two weeks, complications can still arise in this short time. To avoid clogging the tube, the probe should be flushed with water or another clear liquid after each use. If this does not happen, some probes can no longer be used very quickly.
Fixing the feeding tube too tightly to the body surface can also cause problems. This can lead to inflammation and destroyed tissue over a longer period of time due to the high pressure. Therefore, the probe should not be attached too tightly and should be checked more frequently.
With a PEG probe there is also the risk that it grows into the tissue as it is attached. An attempt is made to prevent this by loosening and moving it several times a week. Due to the high level of invasiveness with the associated damage to the skin, infections can also occur in the area of the entry point into the body. The wound edges should be cleaned and disinfected more frequently to prevent infection.
Gastric tube after stroke
After suffering a stroke, it may be necessary to insert a gastric tube. The reason for this is that the motor and mental abilities of the person concerned can be severely restricted. Depending on the affected area of the brain, it can even go so far that nutrition is no longer possible. A disturbed diet can have a strong negative impact on healing.
For people who are in a coma after suffering a stroke, a nasogastric tube is required anyway. The supply of medication alone requires this. Furthermore, most people who have a stroke also belong to an older age group. Since the supply of food and fluids can generally be difficult here, it can become impossible due to a stroke. The use of a nasogastric tube is also indicated here.
In these people and in people who suffer from a stroke at a young age, the time to self-sufficiency can be bridged well through a gastric tube. As soon as it becomes clear that the tube feeding has to be longer, the use of a PEG tube should be considered. This is also more reliable in the long run for people with a stroke.
Read more on the topic:
- Signs of a stroke
- What are the consequences of a cerebral hemorrhage?
- Stroke therapy
How long must / can you leave a nasogastric tube lying around?
The duration of the possible use of a gastric tube depends on whether a conventional gastric tube or a PEG tube was used.
While conventional feeding tubes are designed for short to medium-term use, the use of a PEG tube can ensure nutrition over a longer period of time. Conventional probes should be used for a maximum of two weeks. A change must then be made. If the symptoms persist, such as gagging through the tube in the mouth and throat, a change may be necessary earlier.
In contrast, with appropriate care, a PEG probe can even be used permanently for several years. However, it should be ensured that the necessary measures are taken if complications arise. This would be, for example, disinfecting the edges of the wound. If there is still no improvement, the feeding tube should be changed.
It applies to all feeding tubes that they should be left lying around or changed in the meantime until the supply of food, fluid and medication can reliably take place independently.
When do you have to put a feeding tube through the abdominal wall?
There are several reasons why a feeding tube should be placed through the abdominal wall. The most common reason for the insertion of a PEG tube is the inability to insert another gastric tube. This occurs, among other things, in patients with mechanical occlusions of the upper food tract, such as the mouth, throat and esophagus.
A PEG tube is also used when an operation is pending that affects this area. This minimizes postoperative stress. This is the case, for example, after an operation in the area of the jaw. Burns can also cause it. In tumor patients with a tumor in the upper food passages, it can happen that the food passages are free. In this case, however, a PEG probe is preferred since there is no risk of tumor cells being carried over when it is applied.
Read more on the topic: Therapy of esophageal cancer and esophageal narrowing
If there is a risk of stomach contents entering the airways through a gastric tube, a PEG tube is also used. The risk of aspiration is lower.
Furthermore, a PEG tube can be advanced into the small intestine. This means that it can be used when the lower stomach opening is closed. Furthermore, a long service life is an indication for a PEG tube. This can be used for a very long time compared to conventional gastric tubes. It is especially popular with long-term illnesses or old age with associated malnutrition.
Gastric tube complications / risks
Besides the advantages, the installation and use of a nasogastric tube offers some risks. The most common injuries are the lining of the mouth, throat or esophagus. This is painful and can lead to bleeding. As a rule, these are not serious. However, a not insignificant amount of blood can be lost if the blood clotting is impaired.
Sometimes a feeding tube is not positioned correctly. This can either reduce the outflow of stomach contents (such as during an operation) or direct food, fluids, and medication into the windpipe. Therefore the situation should always be checked.
Long-term use can also lead to ulcers and inflammation of the mucous membrane due to excessive pressure. With PEG tubes there is also the risk that the entry point on the skin will become inflamed. This point can still be leaking and thus cause further problems. Furthermore, the probe can grow into the gastric mucosa and cause an inflammatory reaction.
The most common complication is a blockage of the hose. Therefore, it should be rinsed after use.
How can one control the correct situation?
The correct position of the gastric tube can be checked in various ways.It is easiest to eavesdrop on the stomach area. To do this, air is forced through the hose with a syringe. When correctly positioned, the stethoscope should emit a bubbling sound. Liquid can also be sucked in through the probe.
The pH value of this secretion can be determined with the help of test strips. If it is acidic, gastric juice is present and the probe is correctly positioned.
As a final measure, the correct position can be checked using an X-ray. This procedure is only used if all other methods have not delivered a reliable result, as it is very time-consuming and stressful.
