Technique for inserting a nasogastric tube. – Blog and articles about medicine and health

Preparing for the procedure.

It is necessary for the doctor to establish a trusting relationship with the patient or his relatives.
The doctor must tell the patient the purpose of the upcoming procedure and familiarize him with what food he will be given. The doctor should also tell you about the stages of the upcoming procedure. The room should be ventilated in advance. The next stage of preparation for inserting the probe is measuring the distance from the throat to the stomach. To do this, the patient must sit up straight. Then the doctor should take a measurement. There is an alternative way to calculate the distance to the stomach; to do this, you need to subtract 100 cm from the person’s height. In order for the nasogastric tube to easily enter the stomach, it is recommended to moisten it in the Furacilin solution. The solution is diluted in a ratio of 1 to 2000. The nasogastric tube is wetted to the marked mark. Next, you should put the patient on the couch. He lies down on his back. A pillow is placed under the head. It is necessary to make sure that the head is slightly tilted. This position will ensure free insertion of the probe into the nasopharynx. A napkin is placed on the patient's chest. The doctor must carry out this procedure wearing gloves.

Main indications for use

Eating through a tube is carried out in cases where the patient is not able to do this on his own. His swallowing function is depressed, there is no clear consciousness, or there are serious lesions in the throat and oral cavity. The probe is most often installed in the following cases:

After a stroke, if we are talking about damage to the areas of the brain that control the swallowing reflex, the function may be partially or completely inhibited. A return to normal eating habits is possible after completion of rehabilitation. In case of extensive damage and advanced age of the patient, enteral nutrition can be permanent.
For physical injuries - head injuries, severe swelling of the tongue and larynx.
If the patient is in a coma or unconscious.
With the development of psychological disorders, when the patient refuses to eat.
Neurological diseases (multiple sclerosis, Parkinson's, Alzheimer's), accompanied by corresponding disorders.
During surgical interventions in the gastrointestinal tract.

Enteral feeding is prescribed in cases where the traditional form of eating is impossible or difficult, if the patient may choke, or if incoming food may infect damaged tissues and organs.

Insertion of a nasogastric tube.

Performing the procedure:

Wash and dry your hands. Wear gloves.
Liberally coat the blind end of the probe with glycerin (or other water-soluble lubricant).
Ask the patient to tilt their head back slightly.
Insert the probe through the lower nasal passage to a distance of 15-18 cm and ask the patient to tilt his head forward.
Advance the probe into the pharynx along the back wall, asking the patient to swallow if possible.
Immediately, as soon as the probe is swallowed, make sure that the patient can speak and breathe freely, and then gently advance the probe to the desired level.
If the patient can swallow:
- Give the patient a glass of water and a drinking straw. Ask to drink in small sips, swallowing the probe. You can add a piece of ice to the water;
gently move the probe to the desired mark.
Help the patient swallow the probe by moving it into the pharynx during each swallowing movement.
Make sure the tube is positioned correctly in the stomach:
- introduce about 20 ml of air into the stomach using a Janet syringe, while listening to the epigastric region, or
If necessary, leave the probe for a long time: cut off a 10 cm long plaster, cut it in half 5 cm in length. Attach the uncut part of the adhesive plaster to the back of the nose. Wrap each cut strip of adhesive tape around the probe and secure the strips crosswise on the back of the nose, avoiding pressing on the wings of the nose.
Cover the probe with a plug (if the procedure for which the probe was inserted will be performed later) and attach it with a safety pin to the patient's clothing on the shoulder.

Correct articulation

Any work begins with the child being shown a sound sample. The sound [K] belongs to the group of back-lingual sounds, that is, to pronounce them, the back of the tongue rises. It is from this sound that the rest - [X], [G] and their soft pairs - are made.

Therefore, it is advisable to start the correction with the sound [K]. To pronounce it, the lips take a neutral position or become open. The teeth are open, the tip of the tongue lies at the lower teeth, but does not rest against them. The front and middle backs are lowered, the back ones are raised and rest against the soft palate. The sides of the tongue lightly touch the hard palate. The vocal cords do not tense, the air passes through the closure of the tongue and palate, breaks it and the sound [K] is produced.

Normally, the posterior lingual group appears at an early age. Thanks to sucking, the tongue takes the form of a “slide” and the child is able to pronounce individual sounds.

Difficulties may arise due to a high or narrow palate - in this case, it will not be possible to form a bow. With dysarthria, weakness or tension of individual muscles of the tongue occurs. Sometimes children have poor phonemic hearing. Thanks to it, people distinguish between different speech sounds.

Phonemic (speech) hearing should not be confused with physical hearing! If the first is violated, the child will be able to distinguish non-speech sounds well and respond to the speech of other people, but will poorly perceive what he himself says.

Defective pronunciation of the sound [K] is called kappacism. Sometimes there is no sound, then instead of “Cat” you get “'ot”. The sound may be distorted and a click will be heard instead - this happens due to the bow being too tight.

Replacing [K] with other sounds is called paracappacism. Most often the sound changes to [G], [X] and sometimes to [T]. In this case, in addition to sound production, the speech therapist deals with differentiation.

Feeding through a nasogastric tube.

The probe is lowered to the level of the stomach. Air should not be allowed to enter there. To do this, the funnel is tilted and filled with food. The food should be warm, its temperature should be 38-40 degrees. Once the funnel is filled with food, it is gradually raised up until the food remains only in the neck of the funnel. Next, the funnel descends again down to the level of the stomach. It is then filled with food and the process is repeated in a similar manner. After all the food has been introduced, boiled water or tea is poured into the tube.

After the introduction of food is completed and the probe is washed, a clamp must be installed on its end. Next, remove the funnel. Afterwards, wrap the end of the probe in a sterile napkin or place it in a tray, or you can fix it on the patient’s neck. Leave in this state until your next meal.

Methods of sound production [w]

Olga Petrovna Pak

Methods of sound production [w]

It is necessary to begin speech therapy work with the development of the organs of the articulatory apparatus. In order to interest the child, you should creatively approach this stage of speech therapy classes: come up with symbols for each exercise, make an interesting manual yourself, for example, “Cubes” (glue pictures with articulation and breathing exercises on the edge of the cube).

Method I

By imitation: the child pronounces the sound C several times and during pronouncing should smoothly raise the tip of the tongue towards the alveoli. As the tongue rises, the nature of the noise of the consonant changes. At the moment an acoustically correct sound appears, you need to draw the child’s attention to this position of the tongue.

II method.

By imitation: show the child in front of the mirror the correct articulation of the sound and explain to him that in order to correctly pronounce the sound Ш, the tongue must be made into a “cup,” hidden behind the upper teeth and blown smoothly.

III method.

By imitation and with mechanical help: the child performs the “Fungus” exercise, then the speech therapist asks to “unstick the fungus” from the palate (so that the leg is not visible, and leave the “hat” at the top and blow.

If it was not possible to make a sound by imitation, the child again does the “Mushroom” exercise, and blows with the speech therapist’s thumb placed horizontally under his tongue. Next, the finger is removed and the child pronounces the sound independently.

IV method.

If the sound R is pronounced undisturbed, the child pronounces it in a whisper, and at this moment the speech therapist touches the lower surface of the tongue with a spatula or probe to slow down the vibration.

V method.

The child performs the exercise “Steps” (walks): the first step – the tongue hugs the upper lip, the second – hugs the upper teeth, the third – the tongue “steps” the teeth.

Then the speech therapist teaches the child to do “Focus” - pull the tongue towards the nose and blow off the “cloud” (cotton wool). After which these two exercises are combined: the first step - the tongue hugs the upper lip (blows on the nose); second step – the tongue hugs the upper teeth (blows on the teeth); third step - the tongue is hidden behind the teeth (blow). Next, the child closes his teeth a little, makes his lips “donut” and hisses like a “deflating tire.”

This method of sound production often gives positive results.

VI method.

The main method of producing sound is with mechanical assistance from the sound S.

The child is encouraged to pronounce the sound C protractedly 2-3 times, checking for the presence of an air stream. Following this, when the lips are positioned in a smile, a spatula, spoon or probe is placed under the tongue and the instruction is given: “We will bake a pancake,” for which the speech therapist relieves the pressure on the child’s tongue, lifting it up and bringing it to the alveoli, and asks the child to whistle. When pronouncing the sound C, the teeth gradually move closer together; use a spatula to adjust the best acoustic effect.

After the sound has appeared, it is necessary to consolidate its isolated pronunciation using different game moments. For example, while the tire is “deflating,” the child can hiss and draw a path on a piece of paper, connect his fingers, making rings. These exercises arouse interest in the child and allow you to simultaneously develop fine motor skills.

How will you feel?

Slight pain in the nasal cavity, pharynx and vomiting are possible, but not all patients experience this. It is important to listen to your doctor's commands and breathe properly through your mouth. Almost all patients tolerate both this manipulation and treatment with an installed probe satisfactorily. Don't worry, nasal breathing will continue. Sometimes it takes 2-3 days to get used to the probe. In extreme cases, the doctor may prescribe painkillers, antiemetics and antispasmodics. At first, you need to listen to yourself and understand what position you should be in in order to reduce discomfort in this area. The main thing is to remain calm and remember that this is a necessary and temporary measure. According to many patients, their fears about inserting a probe were greatly exaggerated.

Probe installation service at home in Moscow

You may need to order the installation of a nasogastric tube at home in Moscow:

for acute pancreatitis;
after surgery to treat intestinal obstruction;
with injuries to the tongue, pharynx, esophagus or abdomen;
during the rehabilitation period after partial gastrectomy;
after suturing a perforated ulcer;
to make eating easier for patients who suffer from nervous regulation disorders;
with fistulas of the esophagus or its pathological narrowing.

However, the procedure also has several contraindications: ulcers in the acute phase, pathologies of the hematopoietic system (for example, hemophilia and bleeding disorders of other origins), varicose veins of the esophagus, serious injuries to the skull bones. The consultant will definitely warn you about this when clarifying the details of ordering the service.

Specialists also take into account the age characteristics of the patient - the size of the probe is selected individually. Typically, tubes ranging in length from 38 to 120 cm are required to accommodate each client's anatomical needs.

Frequently asked questions from our patients

Our clinic specialists have extensive experience in performing this procedure. Therefore, the installation will be safe, which reduces the risk of negative consequences to a minimum.

We will select effective analgesics for you, which will reduce discomfort.

The device is installed for up to 30 days. But we recommend using it no longer than 2.5 weeks.

Yes. The technique for inserting a probe into children is practically no different from installing a system for adults.

Feeding process

The procedure is carried out according to the following algorithm:

The patient's body is given a semi-sitting position;
The outer part of the probe is lowered below the patient’s neck and compressed with a special clamp;
The funnel is connected to the syringe, it rises to a level of up to half a meter above the stomach, after which the clamp is removed.
Food is served slowly, with virtually no pressure; no more than 150 ml should be administered in 5-6 minutes.
After finishing feeding, it is necessary to rinse the area by applying 30-50 ml of water through it.
Next, the tube is clamped again, lowered, and the inlet is closed with a plug.

Tube is a modern and effective way of feeding seriously ill patients. It has a lot of advantages. Unlike intravenous nutrition, in this case atrophy of the gastric mucosa is not allowed, the gastrointestinal tract system remains in working order. The enteral system can be used for a long time. The probe is installed for three weeks. The administration procedure must be carried out by a doctor, and he must also give his recommendations regarding the feeding procedure and diet.

Nutritional Features

If the patient feels normal after installation, you can start eating immediately. All dishes served must have only a liquid consistency. They should be warm, that is, temperatures of 37-39 degrees. Hot foods may cause burns.

It is necessary to increase the volume of servings gradually; the first two or three times it should not be more than 100 ml. In the future it can be increased to 300 ml. The following products are best suited for enteral nutrition:

Kefir;
Fish, meat, vegetable broths;
Thoroughly mashed puree;
Rare porridges, especially semolina;
Special mixtures.

Ready-made dry mixtures can be used as a basis for nutrition or in addition to the diet. They are rich in protein, which bedridden patients often lack.

The number of meals should be no more than 5, but not less than 3. A sterile syringe must be used for administration each time. The nursing service specialists strictly follow all the rules for feeding through zones and carefully monitor the hygiene of the entire process.

Advantages of installing probes at home

A complication of a stroke with loss of the swallowing reflex or various injuries to the esophagus - such conditions will definitely not allow you to eat comfortably. Installing a nasogastric tube at home will completely solve the problem. Advantages of the ordered service:

Maximum convenience. The patient will be relieved of worries, because the nurse will tell you how to tune in to the procedure in advance and how to breathe while the probe is advancing. Familiar surroundings will help you relax, and you won’t have to “shake” in public transport on the way back.
Quality of the procedure. Services are provided only by certified nurses with extensive experience.
Nice service. No meaningless conversations, siphoning off funds or absurd recommendations. A specialist will come to your home and do his job competently.
Affordable prices. Installing the probe will not incur significant financial costs.
Response speed. In Moscow there are no nurses as efficient as those from MedinHome, who get to the patient in the shortest possible time.

In order to clarify the cost of the procedure, you need to contact the dispatcher by contact number or WhatsApp.

Benefits of a home nurse from MedinHome

Always the right result

No unnecessary procedures, offers to buy a panacea in your pharmacy and pumping out money, which visitors to clinics have long been accustomed to

Quality and safety

Only certified nurses with recommendations, confirmed qualifications and many years of experience provide services.

Saving your time

Medical care at home will save you from having to stand in traffic jams and queues. The nurse will arrive at the address you specified at a pre-agreed time