Feeding tube

As a gastric tube is called in medicine a tube that is advanced through the mouth or nose along the natural upper digestive path, ie by the throat and esophagus to the stomach. This distinguishes it from the PEG tube that is placed through the abdominal wall.

Indications

A nasogastric tube is indicated for food, fluid and drug delivery (artificial diet ) in the ICU or in the oral and maxillo- facial surgery at the impossibility of a normal passage of the upper digestive tract ( mouth, pharynx, larynx, esophagus ), for B. dysphagia or inability of food intake by mouth (eg due to wiring between the upper and lower jaw). Another indication is the derivation of gastric contents, for example, before, during or after surgery of the abdomen, intestinal obstruction (ileus ) or after oral ingestion of poisons ( alcohol, pills, thinner, acid ... ). A gastric tube can also be used for stabilizing / splinting of the esophagus during surgery.

Occasionally carried an insert to feed hunger strikers or anorexics against their will. Not infrequently, is obtained via a nasogastric tube gastric fluid for diagnostic purposes.

A gastric tube is easy to lay and therefore more suitable for short-term applications, a PEG tube is more expensive to create ( endoscopic surgery), to entertain ( dressing changes ).

Contraindications

A nasogastric tube should not be inserted at major injuries or tumors of the mouth and throat or esophagus. Also varicose veins in the esophagus ( esophageal varices ) or burns of the esophagus are contra- indicators. Other exclusion criteria are infections of the sinuses, as well as injuries and fractures of the facial skeleton. A relative contraindication is the presence of a coagulopathy.

A nasogastric tube should not be placed when no other indications exist as to simplify and accelerate the diet.

Complications

Despite the potential complications listed below the system of a gastric tube is generally unproblematic. It is possible in the awake patient. Serious complications through the system are rare.

Complications of plant

In the plant can cause vomiting by triggering the gag reflex or epistaxis in inserting the probe through the nose. Injuries, that is, Perforation of the nasal, throat, bronchi or the esophagus, are rare. In some cases there has been a breakthrough through the skull bone and thus to the intracranial position of the gastric tube. With the release of vagal reflexes may occur bradycardia or in extremely rare cases lead to cardiac arrest. Also, increase in the exposure of the stomach probe, the heart rate, because the uncomfortable feeling which causes stress.

Complications in long gastric tube

Prolonged hospital stay can cause pressure points ( ulcers ) or decubitus come to the nostril, nasal mucosa, pharynx, esophagus and stomach.

The probe may slip ( dislocation ) when ( for example, when repositioning the patient) accidentally dragged it. It can be regurgitated by the patient and by vomiting. There remains the fixation of the probe to the nose or mouth undamaged, the gastric tube can be wound in the throat. If this is not noticed by the nursing staff, achieved administered tube feedings not the stomach, but the throat. If the patient does not have adequate protective reflexes ( swallowing reflex, gag reflex, cough reflex), the tube feedings can get into the windpipe ( aspiration).

Aspiration may also occur if the patient vomits beside the gastric tube or regurgitated or are not sufficiently protective reflexes ( swallowing reflex, gag reflex, cough reflex) has. Such an aspiration can cause pneumonia. Due to the gastric tube infection of the sinuses (sinusitis) are favored.

Materials utilized

Stomach probes are made ​​of different materials. Most are polyvinyl chloride, polyurethane or silicone. All probes are generally made so that they are displayed radiographically.

Probes made ​​of PVC have a length of stay more than one week, as the plasticizer contained in the PVC to resolve after a week from the material and then the probes are rigid. Polyurethane and silicone have a hospital stay of up to 6 weeks. The soft material loses no plasticizers and is esophagus and mucous membranes. Silicon probes have a thick wall and narrow lumen, feeding tubes made ​​of polyurethane, a thin wall thickness and wide lumen.

A distinction is made according to size, length ( 100-130 cm ) and number of lumens (2-3 can explore different places ). The most common sizes are: CH 6-8 for newborns, CH 8-10 for toddlers, CH 10-12 for children, CH 12-18 for adults

Upkeep and maintenance

Through the probe normal food can be administered unless it is liquid enough to do so. In today's medical environment, however, almost exclusively industrially produced liquid food ( tube feeding ) will be used. It is almost to find any dietary composition on the supply list of their respective companies.

Before each administration of the liquid food or a position control must be performed to ensure that the probe is not slid into the trachea. The probe position is further assess once per shift. After the administration, the stomach probe is typically flushed with 50 to 100 ml of clean water. Gastric tube is to carry out an extensive nose care at least once daily.

Once a day or as required is the secretion bag to switch to measure the content and recorded. The probe bag must be fixed to the bed so that no train on the probe arises and the secretions can drain well. Depending on the physician arrangement, the secretion is fractionated or permanently dissipate. A probe exchange takes place depending on the material and constipation.

Longer feeding tubes: duodenal and jejunal tube

Depending on the length of the probe in the stomach ( gastral ), in the duodenum ( duodenal ), or terminate in the small intestine ( jejunal ). In double- probes the Lumina usually end at different locations to lie in two different sections of the intestine so that they come (eg, an opening in the stomach, the other in the duodenum ( duodenum) ).

At installation of a jejunal tube ( tube into the small intestine), the patient must be stored on the right side and if necessary to lift the pelvis. A Paspertingabe is displayed. The Jejunalsondenlagekontrolle made ​​by a sample to litmus paper (pH greater than 7 ), air insufflation and X-ray. The special feature of the jejunal tube is the continuous application of the probe, since the jejunum can not absorb large amounts at once, like the stomach.

Special Features of tube feeding of infants and young children

Under probe dependence or -Dependence is defined as the unintended physical and emotional dependency of an infant or small child from an originally planned as a temporary exploratory with the lack of a medical indication. The permanent diet has a probe, a development deficit in the development of the child result, which is why their removal often appears to be indispensable.

In infants and young children to transition a tube weaning with training of chewing and swallowing motor skills necessary to self- feeding.