THE NASOGASTRIC Ovidiu Fabian

Learning objectives What you should know  What is  What is its purpose  To know the materials which are necessary for the nasogastric intubation  How to measure the length of the catheter to be introduced  The technique of performing the nasogastric intubation  How to assess the position of the catheter  What kind of incidents might appear  What is the duodenal intubation  The technique of performing the nasogastric intubation  What is the gastric lavage  Which are the indications and contraindications of the gastric lavage  The technique of the gastric lavage

What you should do  Collect the necessary materials  Measure and mark the intubation length of the catheter  Perform the nasogastric intubation  Check the catheter position by attaching the syringe and aspire  Fix the catheter  Describe the stages which cannot be performed practically on the model (positioning, choosing the nostril etc. )

Definition The nasogastric intubation is a procedure through which a tube is introduced into the lumen. The procedure allows the evacuation of the stomach, getting a sample from the gastric content, as well as gastric lavage or introducing some substances in the gastric lumen.

Indications  Evacuating the stomach in case of gastric stasis o During the post- period, when there is a reactive digestive paresis o In the case of the patients with bowel obstruction  Evacuating the stomach in case of recent ingestion of toxic substances (not caustic!) o May be completed with gastric lavage  Evaluating a superior digestive bleeding o The blood content confirms the bleeding o The red aspect of the aspired blood shows a recent/active bleeding o The coffee grounds aspect (digested blood) shows an older bleeding o Clarifying the gastric aspirator which was initially full of blood shows the bleeding has stopped o Fresh blood on the catheter shows the bleeding is back  Getting a sample of gastric juice for laboratory study o To determine total acidity, free acidity o Very rarely; this indication has lost importance in time  To introduce some substances o The gastric lavage with cold physiological serum (with adrenaline) as temporary hemostasis method in a superior digestive bleeding, if the therapeutic cannot be performed rapidly o Feeding (for example for feeding a prematurely newly- born child or a patient in come)

Contraindications  Severe facial injury  After a recent nasal operation  After the ingestion of caustic substances o The chemical burn weakens the wall and the intubation may perforate the esophagus  After the flexible ligature of the esophagus varices o Relative contraindication; in fact the risk of detaching the flexible rings with the catheter is low

Observations  The nasogastric catheter goes through one of the nasal fossa, pharynx, esophagus and stomach o  o o o o

Necessary materials  o o o . – . – . – . – o o Figure 1. o . ’ . ’– . o . . ’    –      

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o Choose the nostril through which the air passes more easily

Figure 2. Fowler position

Figure 3. Choosing the nostril

Preparing the catheter  Take out the catheter from the packaging  Measure the length of the catheter to be introduced o The end of the tube is held at the tip of the nose and the tube is applied on the same side ear lobe (this distance corresponds to the distance from dental arch to the pharynx) o Then measure the distance to the ear lobe at 4-5 cm below the xyfoid appendix o Apply a sign on the settled place (with an adhesive band or a marker)

Figure 4. Measuring and marking the catheter  The catheter must be at hand, next to the other materials

The technique  Collect the necessary materials, which will be placed on a table at hand       – o o    o o

Figure 5.

 o o o o  Figure 6.  o o Figure 7. o . . . . ≤ o  o  

Figure 8. Incidents and accidents  Epistaxis o Very rarely, if the catheter is handled brutally and is insufficiently lubricated  The catheter mat pass into the larynx or trachea o It determines suffocation sensation or cough o If the breathing signs are minor the patient is requested to speak; if the patient can pronounce words, then the catheter has not passed glottic closure o In the case the tube followed the respiratory pathway the catheter is taken out and the procedure is resumed after the patient calms down  Catheter coiling in the pharynx o When pushing the catheter the advancement feels difficult o We ask the patient to open the mouth widely and notice that the catheter is coiled or it got in the oral cavity o Take out the catheter and resume procedure o Id the patient is sedated or in coma you can check the catheter position with the laryngoscope; under its control the catheter can be directed with a clip  Catheter coiling in the esophagus o When aspiring no gastric content is coming through the catheter o In case of doubt you can use radioscopy to check the catheter position

Duodenal intubation  The duodenal intubation consists in introducing the catheter in the duodenum to take a sample of duodenal juice  The indications for duodenal intubation are few at the moment o Taking a sample of duodenal juice for the diagnosis of certain parasitoses (giardiasis) o In the past it was used for the diagnosis of billiary disorders; nowadays using duodenal intubation to this purpose is not justified  Perform the nasogastric intubation following the procedure above; to place the nasogastric catheter in the duodenum follow this procedure: o “”   o o

The gastric lavage   Indications o . . . o .  Contraindications o . . o .  Necessary materials o . – . Figure 9. o  The gastric lavage technique o o o o o o Figure 10. Tha gastric lavage o o 

Assessment / self-assessment form

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