Coma patients in ICU nursing nasogastric tube difficult
【Key Words】 ICU coma patients nasogastric tube
Patients with indwelling gastric tube is a common basic nursing skills with clinical work in the ICU, because of enteral nutrition and
treatment of gastrointestinal pressure such as the need is particularly common for patients, gastric intubation. Can be often seen clinically in some coma, endotracheal intubation, or critical illness stomach tube into difficult situations. Despite the introduction of die guide and
endotracheal tube guide, massage parlor stomach tube, changing position and the trachea and the catheter inserted on to mention other measures to help the stomach tube, but still desired, catheter easily coiled several times in the throat or the need to test plug, both to increase the suffering of the patients, but also increased the workload of nurses [1,2]. In clinical work, the authors collected from January 2006 to December 2007 the difficulties encountered in clinical catheterization
cases, analyzes the reasons for catheterization difficult to sum up the experience of the appropriate method of gastric intubation to improve the success of intubation rate, now approach described below.
A clinical data
1.1 General Information
The group of 11 patients, 5 males and 6 females; aged 56 to 89 years old, with an average 64-year-old. 10 cases in which tracheotomy,
intubation 1 case; were comatose; four cases of cerebrovascular accident, neuromuscular disease, respiratory failure, cardiovascular disease, 2 cases, other 1 case. 11 patients underwent mechanical ventilation. Cause gastric intubation are OK enteral nutrition. Gastric intubation under direct vision laryngoscopy were performed, 8 cases were successful, three
cases of failure; losers fiberoptic gastroscope stomach tube under the guidance of success.
1.2 Operation Method
(1) laryngoscope gastric intubation under direct vision: Select model suitable stomach tube, measuring a good length (usually 45 ~ 55 cm), using
liquid paraffin lubricated stomach tube front end, with a net suction suction mouth and nose secretions, and then holding his left hand laryngoscope stretching along the right side of mouth mouth, to see the esophagus after importation, but also can make use of the oval forceps-
assisted, will gastric tube into the esophageal entrance, insert the desired length, the insertion process, such as greater resistance to supporting the use of guide wire insertion, check the gastric tube in the
stomach, it will laryngoscope exit, fixed stomach. (2) fiber gastroscope choice model under the guidance of the right gastric intubation gastric tube, clean the nose with wet cotton swab to measure the length (usually 45 ~ 55 cm), with paraffin oil lubricated gastric tube, nasogastric tube
placed before the first of its lubrication from the nose after the insertion, some into the 15 cm, into the endoscopy, nasogastric tube in the throat can be seen with foreign bodies in head-end clamp to live
nasogastric tube should be back near the stomach foreign body forceps to push the lens-side to facilitate gastroscopy, Nasal endoscopy with a gentle push off of esophageal intestinal singalong to the esophagus, the stomach cavity to push endoscopy at this time intestines assistant fixed
the nose, release the foreign body forceps, foreign body forceps back and gastroscopy fixed stomach.
(1) In gastric intubation process, if the difficulties encountered laryngospasm inserted, to the throat spray a little lift laryngospasm
tetracaine, if encountered in esophageal spasm, can also be used 50 mg of lidocaine plus normal saline to 10 ml by slowly pushed into the stomach to relieve the spasm, so that a smooth stomach tube inserted; (2) For patients with restless unconscious before the operation, should be adequate sedation, intravenous injection of propofol may be 20 ~ 60 mg, or midazolam 5 ~ l0mg; (3) tracheotomy patients, into the process, gas cutting resistance can be fully part of the event to attract and proper
under the premise of a fixed casing to be deflated balloon, and adjust the casing, and make the stomach tube can be smoothly adoption; (4) fiber gastroscope-guided gastric intubation at the ICU bedside need to be conducted to facilitate rescue. Reposted elsewhere in the paper for free download http://
Difficult to stomach tube reasons:
(1) repeated intubation leading to vocal cord damage and glottis
edema, and even esophageal mucosal edema; two cases in this group in the
laryngoscopy or fiber endoscopic intubation proved to be due to repeated failures caused by throat swelling, difficult intubation; (2) It has been reported [2,3] bilateral recurrent laryngeal nerve injury, no difficulty swallowing reflex is one of the reasons catheterization; but no such
patients in this group; (3) injury caused by inflammatory swelling of the neck and trachea, this group of 8 tracheal intubation in patients without catheterization difficulties, tracheotomy after a ~ 2 weeks, appears
difficult to stomach tube, of which 3 patients required catheterization guided by gastroscope were the case, after the gastroscopy found in the next intubation for tracheotomy tube compression or injury of the esophagus caused by inflammatory swelling caused by stomach intubation
under general strayed into the trachea, while normal gastric tube hardness toughness is poor, operations, easy to bend, thereby affecting the gastric tube insertion; (4) tracheal tube cuff inflated esophagus after the oppression of this group of patients were mechanical ventilation, in the laryngoscope-guided balloon can not be inserted does not release the 3 patients in the intubation process by line Fang balloon method, smooth stomach tube insertion.
Critically ill patients in coma gastric intubation, because of swallowing function of patients with no, or comatose for several days without eating, esophagus in a closed state, or a tracheotomy and tracheal intubation after the oppression of esophageal and other reasons, when the
gastric tube inserted into the throat department, easily formed by bending up or down twisting, resulting in tube failure. Gastric intubation under direct vision laryngoscope method is simple and practical, trauma, less complications, is a safe, effective and convenient way, especially for tracheotomy or endotracheal intubation of patients in this group of difficult to set control patients, 73% of patients may, by gastric intubation under direct vision laryngoscope tube method of success, this
method worthy to be popularized. For gastric intubation under direct vision laryngoscope failure patients, the authors assist into the application of endoscopy, the success rate of 100%, at present fewer complications, is a safe and effective method, but because of endoscopic
assistance to home tube operation complicated and more expensive. Endoscopic assisted tube feeding tube could be placed in the descending duodenum or jejunum, thus assisting in gastroscope tube often used in enteral nutrition tube or difficult catheterization of patients .
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2 Wang Dongqing, Zhang Leibo. Video laryngoscope in patients with gastric tube insertion in difficult applications. China Nursing Journal,
2007,42 (11): 1041 ~ 1042.
3 Wang Hongxiao. Tracheotomy patients with consciousness disturbance associated with gastric tube placement. Chinese Nursing Journal, 2001,36 (2): 89.
4 OU Xi-long, Sun Wei-hao, in Cao, et al. Endoscopy-assisted
nasogastric tube and the jejunal feeding tube placement. World J Gastroenterol, 2007,15 (6): 655 ~ 665. Reposted elsewhere in the paper for free download http://