THE NASOGASTRIC INTUBATION Ovidiu Fabian
Learning objectives What you should know What is nasogastric intubation 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 stomach 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-surgery 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 endoscopy 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 esophagus 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 . . ’ –