Depth of insertion of the gastric tube. Algorithm for inserting a gastric tube through the mouth

14.07.2019 -

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Author: Averina Olesya Valerievna, candidate of medical sciences, pathologist, teacher of the department of pathological anatomy and pathological physiology

Nasogastric tube- this is a tube inserted into the patient through the nasal passage into the esophagus and further into the stomach for various purposes.

The main purposes of inserting a nasogastric tube:

Nutrition for a patient who various reasons cannot eat by himself.
Decompression of the stomach in case of difficulty in the natural passage of its contents into the intestines.
Aspiration of gastric contents.
Administration of drugs.

Indications for insertion of a gastric tube

The most common situations when inserting a nasogastric tube is necessary are:

Intestinal obstruction (as an element of complex conservative therapy, and also how preoperative preparation or postoperative stage).
Acute pancreatitis.
Injuries to the tongue and pharynx.
Postoperative period after resection of the stomach, intestines, suturing of a perforated ulcer, resection of the pancreas, and other operations on the abdominal and thoracic cavities.
Unconscious state of the patient (coma).
Mental illnesses in which a person refuses to eat.
Difficulty swallowing as a result of the lesion nervous regulation(diseases of the central nervous system, condition after a stroke).
Abdominal injuries.
Fistulas of the esophagus.
Strictures (narrowing) of the esophagus, passable for the probe.

Preparing for probe insertion

Staging gastric tube This is usually a life-saving intervention. It does not require any special preparation. If the patient is conscious, it is necessary to explain the essence of the procedure and obtain his consent.

Contraindications to probe insertion

Contraindications to the installation of a nasogastric tube are:

Facial injuries and skull fractures.
Varicose veins of the esophagus.
Hemophilia and other bleeding disorders.
Stomach ulcer in the acute phase.

What is a nasogastric tube?

A nasogastric tube is a tube made of implantable, non-toxic polyvinyl chloride (PVC) or silicone. The medical industry produces modern probes of various lengths and diameters, for adults and children.

AND PVC and silicone are resistant to hydrochloric acid, with correct use do not lose their properties for 3 weeks.

Nasogastric tube

Main types of probes:

Standard.
Enteral feeding tubes. They are significantly smaller in diameter and have a rigid conductor for easy installation.
Dual-channel probes.
Orogastric tubes. They have a larger diameter and are designed for gastric lavage.

The main features that a modern probe should have for ease of use:

The end of the probe inserted inside must be sealed and have a rounded, atraumatic shape.
At the end of the probe there are several lateral holes.
The probe must be marked along its length.
At the outer end of the probe there should be a cannula for connecting the feeding system (preferably with an adapter).
The cannula should be closed with a convenient cap.
The probe should have a radiopaque mark at the distal end or a radiopaque line along its entire length.

Technique for placing a nasogastric tube

If the patient is conscious, the placement of the probe is as follows:

Before inserting the probe, it must be kept in the freezer for about an hour. This gives it the rigidity necessary for insertion, as well as low temperature reduces the gag reflex.
Position – sitting or reclining.
The patient is asked to close first one nostril, then the other, and breathe. This determines the more passable half of the nose.
The distance from the tip of the nose to the earlobe is measured and a mark is made on the probe. Then the distance from the incisors to xiphoid process sternum, a second mark is made.
Held local anesthesia nasal cavity and pharynx with a spray of 10% lidocaine.
The end of the probe is lubricated with lidocaine or glycerin gel.
The probe is inserted through the lower nasal passage to the level of the larynx (to the first mark).
Next, the patient should help further advance the probe by making swallowing movements. To make swallowing easier, water is usually given in small sips or through a straw.
The probe is gradually advanced into the stomach (up to the second mark).
Check the position of the probe. To do this, you can try to aspirate the gastric contents with a syringe. You can inject 20-30 ml of air with a syringe and listen to noises over the stomach area. A characteristic “gurgling” indicates that the tube is in the stomach.
The outer end of the probe is fastened with a pin to clothing or glued to the skin with an adhesive plaster. The cap is closed.

If the patient is unconscious:

Inserting a probe into a patient in a coma poses certain difficulties, since there is a high risk of the probe getting into Airways. Features of gastric tube insertion in such patients:

When inserting the probe, the doctor inserts two fingers of his left hand deep into the pharynx, pulls the larynx up (along with the endotracheal tube, if available) and back side fingers inserts a probe.
It is advisable to confirm the correct position of the probe in the stomach with radiography.

Video: insertion of a nasogastric tube

Possible complications when inserting a nasogastric tube

The probe gets into the respiratory tract.
Nosebleeds. Bleeding can occur both during the installation of the probe and in the delayed period as a result of pressure sores of the nasal mucosa.
Perforation of the esophagus.
Pneumothorax.
Sinusitis.
Reflux esophagitis, ulceration and stricture of the esophagus.
Aspiration pneumonia.
Mumps, pharyngitis due to constant breathing through the mouth.
Water-electrolyte disturbances with constant long-term aspiration without replenishment of losses.
Infectious complications (retropharyngeal abscess, laryngeal abscess).

Caring for the decompression tube

A gastric decompression tube is installed for a short period of time (a few days at most). The goal is to aspirate gastric contents to relieve the underlying parts of the digestive tract a (for obstructive and paralytic intestinal obstruction, pyloric stenosis, after organ surgery abdominal cavity).

Aspiration is carried out several times a day with a syringe or suction. To prevent the probe from becoming clogged, it is periodically purged with air and changed position (twisted, pulled).

A two-channel probe is often used for continuous aspiration (air flows through one of the channels).

It must be remembered that in this case the patient loses fluid and electrolytes, so the corresponding losses must be replenished intravenous administration under laboratory control of blood electrolytes.

After aspiration, the probe is washed saline solution.

The amount of aspirate is measured and recorded (subtracting the volume of lavage fluid).

You should think about removing the probe if:

Aspirate per day does not exceed 250 ml.
Gases are released.
Normal bowel sounds are heard.

Feeding the patient through a tube

Placement of a gastric tube to feed the patient is carried out for a longer period. This occurs in situations where the patient himself cannot swallow, but the esophagus for the probe is passable. Quite often, patients with a tube installed are discharged home, having previously trained relatives in how to care for it and organize nutrition (usually these are patients with damage to the central nervous system, with consequences of a stroke, inoperable patients with tumors of the pharynx, larynx, oral cavity, esophagus).

The feeding tube is installed for a maximum of 3 weeks, after which it needs to be changed.

Providing nutrition through a tube

The patient is fed through a tube using a Janet syringe or a drip enteral nutrition system. You can also use a funnel, but this method is less convenient.

The patient is placed in an elevated head position.
The outer end of the probe is lowered to the level of the stomach.
A clamp is applied towards the end of the probe.
A Janet syringe with a nutrient mixture (preheated to 38-40 degrees) or a funnel is connected to the connecting port.
The end of the probe with a syringe rises to a level of 40-50 cm above the level of the stomach.
The clamp is removed.
Gradually the nutritional mixture is introduced into the stomach. It is advisable that the mixture be administered without pressure. 300 ml of the mixture is administered over 10 minutes.
The probe is washed from another syringe with boiled water or saline solution (30-50 ml).
The clamp is reapplied.
The probe is lowered to the level of the stomach, and the clamp above the tray is removed.
The plug closes.

Nutrient formulas that can be administered through a tube:

Milk, kefir.
Meat and fish broths.
Vegetable decoctions.
Compotes.
Vegetables, meat purees, diluted to a liquid consistency.
Liquid semolina porridge.
Special balanced mixtures for enteral nutrition (enpits, inpitan, ovolakt, unipits, etc.)

The first portions of food do not exceed 100 ml, gradually the portions increase to 300-400 ml, the frequency of meals is 4-5 times a day, the daily volume of food along with liquid is up to 2000 ml.

Special systems for enteral nutrition are produced. This system consists of a wide mouth PVC formula bag and a tube attached to it, with an adjustable clamp on the tube. The tube is connected to the cannula of the probe and food is delivered to the stomach by drip type.

Video: feeding through a nasogastric tube

Caring for a Patient with a Gastric Tube

Basic principles:

Rinse the probe after each meal with saline solution or still water.
Limit as much as possible the entry of air into the stomach and the flow of gastric contents through the tube (follow all feeding rules and position the tube at the required level; during the period between feedings, the end of the tube must be closed with a plug).
Before each feeding, check to see if the tube has moved. To do this, you can make a mark on the probe after installing it or measure the length of the outer part of the probe and check it each time. If you are in doubt about the correct position, you can try to aspirate the contents with a syringe. Normally, the fluid should be dark yellow or greenish in color.
The probe must be periodically twisted or pulled to avoid bedsores of the mucous membrane.
If the nasal mucosa is irritated, it should be treated with antiseptics or indifferent ointments.
Thorough oral hygiene is necessary (brushing teeth, tongue, rinsing or irrigating the mouth with liquid).
After 3 weeks the probe must be replaced.

Video: caring for a nasogastric tube

conclusions

Main conclusions:

The insertion of a nasogastric tube is a necessary measure, which essentially has no alternative in some situations.
This manipulation in itself is simple, it is carried out by any resuscitator or in emergency situations- a doctor of any specialty.
At proper care a feeding tube may be in the stomach long time, allows you to maintain the energy balance of the body, prolongs the life of the patient.
An alternative to tube feeding is installation. But the disadvantages of installing a gastrostomy tube are that it surgery, which has its contraindications and is not available to everyone.

Inserting a gastric tube through the mouth

Target

Therapeutic.
Diagnostic (gastric lavage is used for stomach diseases, mainly for cytological examination rinsing waters, as well as for identifying poison in case of poisoning and for isolating the pathogen in case of bronchopulmonary inflammation (in case of ingestion of sputum by the patient) and various infectious lesions of the stomach).

Indications

Acute poisoning various poisons taken orally, food poisoning, gastritis with abundant mucus formation, less often - uremia (with significant release of nitrogen-containing compounds through the gastric mucosa), etc.
The need to evacuate gastric contents in order to reduce pressure on the walls of the stomach and reduce the severity of nausea and vomiting associated with intestinal obstruction or surgery.

Contraindications to gastric lavage using the tube method

Large diverticula
Significant narrowing of the esophagus
Long-term periods (more than 6-8 h) after severe poisoning with strong acids and alkalis (possible perforation of the esophageal wall)
Ulcers of the stomach and duodenum.
Stomach tumors.
Bleeding from upper sections gastrointestinal tract.
Bronchial asthma.
Severe heart disease.

Relative contraindications:

acute myocardial infarction,
acute phase stroke,
epilepsy with frequent seizures (due to the possibility of biting the probe).

Equipment

A thick gastric tube and funnel are usually used to lavage the stomach. Washing is carried out according to the siphon principle, when liquid moves through a liquid-filled tube connecting two vessels into a vessel located below. One vessel is a funnel with water, the other is a stomach. When the funnel rises, the liquid enters the stomach, and when lowered, it flows from the stomach into the funnel (Fig. 1).

Gastric lavage system: 2 thick sterile gastric tubes connected by a glass tube (the blind end of one tube is cut off). You can also use a thin probe for these purposes.

- Glass funnel with a capacity of 0.5-1 liters.
- Towel.
- Napkins.
- Sterile container for collecting rinsing water for testing.

- A container with water at room temperature (10 l).
- Jug.
- Container for draining wash water.
- Gloves.
- Waterproof apron.
- Distilled water (saline solution).

Probe length measurement Rice. 2.

There are several ways to measure probe length.

It is necessary to measure the patient's distance from the xiphoid process of the sternum to the ear and from the ear to the nose (Fig. 2).
You can subtract 100 cm from the patient’s height.
It is possible to measure the patient's distance from the incisors to the esophagogastric junction during endoscopy. A mark must be applied to the probe, to which it is wound up.

Patient position

Sitting on a chair, leaning firmly against its back, slightly tilting your head forward and spreading your knees so that you can place a bucket or basin between your legs.
If the patient cannot take this position, then the procedure is performed with the patient lying on his side.
Patients who are in comatose, gastric lavage is performed while lying on the stomach.

Gastric tube insertion technique

It is more convenient for the person performing the procedure to stand to the right of the patient. (photo) Before starting the procedure, the patient needs to put on an oilcloth apron; If he has removable dentures, they must be removed. In case of poisoning with cauterizing poisons (except phosphorus-containing ones), it is advisable to offer the patient to drink 50 ml before washing the stomach vegetable oil. Invite the patient to open his mouth. Right hand insert a thick gastric tube moistened with water to the root of the tongue. Place the blind end of the probe on the root of the tongue. Ask the patient to make several swallowing movements, during which you carefully advance the probe into the esophagus. You can suggest drinking water slowly. During swallowing, the epiglottis closes the entrance to the trachea, while simultaneously opening the entrance to the esophagus. The probe should be advanced slowly and evenly. If you feel resistance when inserting the probe, you should stop and remove the probe. Resistance when inserting a probe, cough, change in voice, vomiting, cyanosis, etc. indicate an erroneous entry of the probe into the trachea. Then the probe must be removed and the insertion procedure repeated from the beginning. If there is no resistance, then you can continue inserting the probe to the desired mark.

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Diseases of the abdominal organs are in many respects the main subject of general surgery. The surgeon must have comprehensive knowledge of anatomy and skill in examining the abdomen. Manipulations of the gastrointestinal tract (GIT) should equally be an integral part of the surgeon’s technical equipment.

The purpose of gastrointestinal probing is to remove gases and liquids from the stomach (less commonly from more distal parts of the gastrointestinal tract) for diagnostic and/or therapeutic purposes, as well as to deliver nutrients or drugs to the gastrointestinal tract.

Probing of the gastrointestinal tract has a rich history, and modern probes are the result of many years of modifications in materials and designs.

1. Indications:
a. Acute dilatation stomach
b. Pyloric obstruction
c. Intestinal obstruction
d. Small bowel obstruction
e. Upper gastrointestinal bleeding
f. Enteral nutrition

2. Contraindications:
a. Recent surgery on the esophagus or stomach
b. Lack of gag reflex

3. Anesthesia:
Not required

4. Equipment:
a. Levin probe or Salem drainage probe
b. Tray of crushed ice
c. Water-soluble lubricant
d. Syringe 60 ml with catheter tip
e. Cup of water with straw
f. Stethoscope

5. Position:
Sitting or lying on your back

6. Technique:
a. Measure the length of the probe from the lips to the earlobe and down the anterior abdominal wall so that the last hole on the probe is below the xiphoid process. This corresponds to the distance over which the probe must be inserted.
b. Place the tip of the probe in a tray of ice to stiffen it.
c. Apply lubricant to the probe generously.
d. Ask the patient to tilt his head and carefully insert the probe into the nostril (Fig. 4.1.).

Fig.4.1

e. Advance the probe into the pharynx along back wall, asking the patient to swallow if possible.
f. Immediately after the tube is swallowed, ensure that the patient can speak clearly and breathe freely, and then gently advance the tube to the marked length. If the patient is able to swallow, have him or her drink water through a straw; As the patient swallows, gently advance the probe.

G. Ensure that the tube is positioned correctly in the stomach by injecting approximately 20 mL of air using a catheter-tipped syringe while listening to the epigastric region. The release of a large volume of fluid through the tube also confirms the location of the latter in the stomach.
h. Carefully tape the probe to the patient's nose, making sure that the probe does not press on the nostril. The probe must be kept lubricated at all times to prevent injury to the nostril. Using a patch and a safety pin, the probe can be attached to the patient's clothing.

I. Irrigate the tube every 4 hours with 15 ml of isotonic saline solution. To maintain proper functioning of the Salem drainage tube, inject 15 ml of air through the outflow (blue) port every 4 hours.
j. Continuous slow suction can be used with Salem drainage tubes, whereas Levin tubes should only be used for intermittent suction of gastric contents.
j. Check the pH of the Stomach every 4-6 hours and adjust it with antacids when the pH is<4.5.
l. Monitor gastric contents if a tube is used for enteral feeding. Use a chest x-ray to ensure the correct position of any tube before using it for enteral feeding.

7. Complications and their elimination:
a. Pharyngeal discomfort
. Usually associated with a larger probe caliber.
. Swallow tablets or small sips of water or ice may provide relief.
. Avoid the use of pharyngeal aerosols as they may suppress the gag reflex and thus eliminate the airway defense mechanism.

B. Damage to the nostril
. It is prevented by good lubrication of the probe and gluing the probe so that it does not press on the nostril. The probe should always be thinner than the lumen of the nostril and should never be glued to the patient's forehead.
. Frequently monitoring the position of the probe in the nostril can help prevent this problem.

C. Sinusitis
. Develops with prolonged use of the probe.
. Remove the probe and place it in the other nostril.
. If necessary, treatment with antibiotics.

D. Probe entering the trachea
. Leads to airway obstruction, which is easily diagnosed in a patient with preserved consciousness (cough, inability to speak).
. Before using an enteral feeding tube, obtain a chest x-ray to ensure the tube is in the correct position.

E. Gastritis
. Usually manifests itself as moderate bleeding from the upper gastrointestinal tract that stops on its own.
. Prevention consists of maintaining gastric pH>4.5 by administering antacids and intravenous H2 receptor blockers through a tube. The probe should be removed as quickly as possible.

F. Nose bleed
. Usually stops on its own.
. If it continues, remove the probe and determine the source of bleeding.
. Treatment of anterior and posterior nosebleeds.

Chen G, Sola HE, Lillemo KD.

Your nutrition comes through a feeding tube, so you need to know how to properly care for and install a nasogastric tube. A feeding tube is placed in your stomach and food will be delivered into your stomach.

Daily care

To avoid premature replacement of the feeding tube, it is necessary to monitor its storage conditions. To prevent the tube from clogging, it is necessary to flush it regularly.

Wash your hands every time before working with the probe or the entire power supply system.
Before applying power check if the probe is installed correctly. To do this, measure the acidity of your stomach contents. Check the position of the probe at least three times a day, or more often if you have doubts about its position. Never start applying power until you are sure the probe is in the correct position.
Rinse probe before and after feeding food and medications. To avoid clogging, do this at least three times a day, using 20-40 ml of water.
To avoid contamination of food or meal kit, use new nutrition set.
Take care of your nose skin: Change the hypoallergenic pad daily, clean the skin thoroughly, if the skin of the nasal opening is damaged, insert the tube into another opening.
Take care of your mouth, teeth and lips: this is especially important if you are unable to eat. It is necessary to brush your teeth once a day, rinse your mouth several times a day, and apply cream to your lips.
The amount of time the probe can be suspended is limited: follow the directions on the packaging.
The probe must be changed every 6-8 weeks.

Checking the probe position

To make sure that food gets to the right place in your body without obstruction, you need to check the position of the probe.

Failure to place a nasogastric tube correctly can lead to potentially dangerous situations and pain in the stomach.

Checking the position of the nasogastric tube by measuring acidity

Equipment:

Syringe;
Indicator paper for determining the pH level;
Water (tap water or water as recommended by your healthcare professional).

Wash your hands before and after checking the position of the probe.
Remove the tip of the probe and attach the syringe to the edge of the probe.
Pull the syringe plunger very slowly and carefully until some liquid appears in the syringe.
Disconnect the syringe from the probe, but do not forget to replace the tip.
Drop a small amount of liquid onto indicator paper.

If the pH level is 5.5 or less, your tube is properly placed in the stomach. Rinse the probe with 20-40 ml of water.

If the pH level is more than 5.5, do not start feeding through the probe. Check the pH level again after 30-60 minutes. If the pH level remains above 5.5, contact your nurse. Do not start feeding power or fluid through the probe.

Note: If you are unable to obtain liquid to check your pH level, try the following:

Lie on your right side, wait a few minutes, then try again.
If you can, and if it is safe for you, try drinking some fluid and then check the tube again.
If you still cannot get fluid, contact your doctor or nurse.

Replacement and installation of a nasogastric tube

You can only install the probe if you have been trained to do so. The technique of placing a nasogastric tube will help you correctly and safely install the tube. Always follow the recommendations!

Equipment for installing a nasogastric tube:

New nasogastric tube, bandage to protect the patient's skin,
Syringe 50 ml,
Tape for ligating the probe,
Water,
Clean scissors
Indicator paper for determining the pH level,
Marking pen,
Gloves.

Take a comfortable sitting or reclining position. Measure the required length of the probe: the distance between the ear and the tip of the nose (A-B) and from the nose to the lower part of the sternum (B-C). Mark this location on the probe with a pencil or tape.
Insert the conductor completely and make sure it is firmly attached to the connector. Exhale through your nose. Choose a nasal opening that makes it easier for you to breathe.
Immerse the tip of the probe in a container of water; this will make it easier to insert the probe.
Tilt your head back and insert the tube into your chosen nasal opening. Lean forward when you feel the tube reach your throat. Continue inserting the tube further. To move the tube down, make a swallowing motion, as if you were drinking water in small sips. Inhale deeply to avoid the gag reflex. Advance the tube carefully, do not put pressure on it. Advance the tube until the mark on it reaches your nose.
Ensure that the tube is inserted correctly by aspirating the gastric contents.
Measure the pH level of the gastric contents. The probe is inserted into the stomach correctly if the pH level does not exceed 5.5. Never start feeding until you are sure that the nasogastric tube is placed correctly.
Rinse the probe with 20-40 ml of water. This will prevent it from clogging.
Pull out the conductor. Do not reinsert the conductor as this may damage it. gastrointestinal tract.
Attach the tube to your nose with tape. Make sure that the tube does not put pressure on your nasal passages. Write down the brand name, diameter and length of the probe.

Never use syringes smaller than 20 ml as they create too much pressure in the tube and may cause it to rupture.

Removing the Probe

To remove the tube, you must carefully pull the tube out of your nose.

Identifying and troubleshooting nasal tubes

My nasogastric tube is clogged

If, while flushing the pipe, you see that water does not flow freely, do not try to increase the water pressure.

First: If possible, use a syringe to remove the liquid at the top of the tube to the point of the blockage.
Second: Rinse the tube carefully warm water using a 50 ml syringe.
Do not use acidic solutions, such as fruit juice or cola, as they may thicken the food in the tube.
If the blockage cannot be cleared, gently squeeze the tube with your fingers as far along its length as possible.
If in this case you are still unable to remove the blockage, very carefully pull the syringe and then rinse again.
If the tube is still clogged, contact your doctor or nurse.

My nasogastric tube came out

At the time next appointment food or medicine, you must have a properly inserted nasogastric tube. This is especially important if you must maintain a carefully calculated fluid balance, or if you must take medications at set time. Otherwise, you will feel hungry, you may become dehydrated, and you may develop symptoms that the medications you take can prevent or control.

A. If you own technique for inserting a nasogastric tube, assemble the necessary equipment according to the instructions given, and insert a new nasogastric tube. If you don't have any of necessary equipment, follow the recommendations below.

Q. If you don't own technique for placing a nasogastric tube, DO NOT attempt to insert a new feeding tube on one's own. Follow the guidelines below.

Keep calm.
Contact the nurse and report that your nasogastric tube has come out. Also tell the nurse your next meal time.
If you do not have a personal nurse or one who is unable to give you time, you may need to come to the ward emergency care. For further advice, consult your healthcare provider.
Call the hospital ahead of time and let them know you are coming in and that you need a new feeding tube inserted. In this case, insertion of a nasogastric tube will be carried out faster, since the department staff will have time to find your medical card and a specialist who can help you.
If you have a spare nasogastric tube, take it with you. This will save staff time as the type and size of tube you need may not be available in the emergency room. The probe that came out should also be taken with you so that the department staff can determine its type.
After inserting a nasogastric tube, tell the specialist who usually installs it for you.
Order a new nasogastric tube so you have a spare in case the feeding tube unexpectedly falls out again.

Note:

Never start feeding anything through the feeding tube until you are sure that the nasogastric tube has been placed correctly.

If you are unable to verify that the tube is in the correct position in the stomach, but the patient is not experiencing discomfort and there were no problems inserting the tube, you can either:

Remove the probe and try inserting again.
Leave the tube in and ask your nurse for advice.

The feeding tube should be removed immediately if the following occurs at any stage of nasogastric tube placement:

The patient has too much coughing or vomiting.
The patient becomes paler than usual.
The tube bends in the patient's mouth.
The tube comes out of the patient's other nasal passage.

The gastric tube is used for both diagnostic and therapeutic purposes. This device makes it possible to examine the contents of the gastrointestinal tract and, if necessary, the duodenum. Externally, a gastric tube is a soft rubber tube. Depending on the purpose, it can be of different diameters: thick and thin.

In what cases is probing prescribed?

Probing of the stomach is an informative and safe procedure. It can be prescribed for many diseases, such as stomach ulcers, gastritis, reflux disease, gastric atony, intestinal obstruction and others. In addition, it is used for artificial nutrition of postoperative patients.

Using a probe, the stomach is washed in case of poisoning with spoiled food or poisons. Also, flushing intubation is carried out in case of stenosis of the gastric inlet and in case of release of toxic substances through the gastric mucosa, for example, in the case of renal failure.

Types of probes. Thick probe

Let us describe the thick gastric tube in more detail. Dimensions of its rubber tube:

length from 70 to 80 cm;
up to 12 mm in diameter;
internal clearance 0.8 mm.

The far end of the tube that will be inserted into the stomach is rounded. They call him blind. The second end of the probe is called open. Just above the curve there are two shapes. Through them, the contents of the stomach enter the tube. Marks are placed at 40, 45 and 55 cm from the rounded end. They correspond to the depth of immersion, that is, the distance from the dentition to the gastric entrance.

Basically, such a gastric tube is used for lavage or immediate obtaining of stomach contents.

Thin probe

This device is in the form of a thin rubber tube, the length of which is 1.5 m. The diameter of this tube does not exceed 3 mm. The end, which is inserted into the stomach, is equipped with a special olive made of ebonite or silver. The olive has holes for the contents of the stomach. There are three marks on the tube: 45, 70, 90. The immersion depth is determined from them. In this case, 45 cm is the distance from the dentition to the entrance to the gastric sac, 70 cm is the distance from the dentition to the pylorus of the stomach, 90 cm is the probe is located at the nipple of Vater.

It is much easier to swallow a thin probe. It almost does not cause a gag reflex and can remain in the stomach for a long time. This allows the use of thin probes to monitor the compartment gastric juice and carry out fractional samples of the contents of the cavity under study.

For nasal insertion of a thin probe, a soft tube without an olive is used. Such a probe is much easier to insert and can be used for much longer. Most often, nasal probes are installed after complex operations or when

Duodenal probe

This type of gastric tube is intended for insertion into duodenum. Such probing is prescribed in cases of liver or biliary tract disease. The probe allows you to aspirate the released bile for examination. The probe is made in the form of a flexible rubber tube, the diameter of which does not exceed 5 mm. The length of the probe is 1.5 m. The end, immersed in the stomach, is equipped with a hollow metal olive with holes. The size of the thickening is 2 by 0.5 cm. Marks are applied to the tube to control immersion. Their location is 40 (45), 70 and 80 cm from the olive. The farthest mark approximately shows the distance from the front teeth to the papilla (duodenum).

The need for enteral (tube) nutrition

For some diseases, patients receive This means that nutrients are introduced into the body intravenously, bypassing the gastrointestinal tract. But such nutrition is not always justified, since the process of absorption of nutrients from the gastrointestinal tract has a number of advantages. The process of introducing nutrient solutions into the stomach or small intestine called enteral nutrition. To do this, use a thin gastric tube with a guidewire. Enteral avoids degenerative changes intestinal walls. This is very important for further recovery.

Probe placement

To correctly install the gastric tube, the patient is prepared for manipulation. If he is conscious, the nuances of the procedure are explained. Be sure to measure blood pressure, count pulse and check airway patency.

Placing a gastric tube through the mouth requires measuring the distance from the teeth to the navel (plus the width of the palm) with a thread. The corresponding mark is placed on the tube from the blind end. The healthcare worker stands at the patient's side and places the rounded end on the root of the tongue. Next, the patient performs swallowing movements, and the healthcare worker advances the probe tube to the appropriate mark.

When placing a probe through the nose, the distance from the protruding part of the nose to the earlobe is first measured, and then from the earlobe to the xiphoid process of the sternum. 2 marks are applied to the tube.