1. Gastric dilatation, pyloric stenosis and food poisoning.
2. Preparation before barium examination or surgical treatment.
3. Intubation for nutritional therapy in coma and extreme anorexia.
4. Oral and laryngeal surgery to keep the surgical site clean.
5. Gastric fluid examination.
6. Gastrointestinal decompression.
(2) Contraindications
Severe esophageal varices, corrosive gastritis, nasal obstruction, esophageal or cardia stenosis or obstruction, severe respiratory distress.
(3) Preparation
1. Train the patient's cooperative movements during intubation to ensure smooth intubation.
2. Preparation of instruments Prepare sterilized gastric tube, curved tray, forceps or tweezers, 10ml syringe, gauze, therapeutic towel, paraffin oil, cotton swabs, adhesive tape, clamps and stethoscope.
3. Check whether the gastric tube is smooth and whether the length markings are clear.
4. Check nasal ventilation before intubation and choose the side of the nostril with smooth ventilation for intubation.
(4) Operation method
1. The patient takes a sitting position or semi-recumbent position.
2. Lubricate the anterior portion of the gastric tube with paraffin oil, hold the gastric tube in the left hand with gauze, hold the anterior portion of the gastric tube in the right hand with forceps, and slowly insert it into the pharynx along the side of the nostril (14-16 cm), and then instruct the patient to make a swallowing movement while sending the gastric tube down to a depth of 45-55 cm (equivalent to the patient's length from the hairline to the xiphoid process). Then the gastric tube was fixed at the nose with adhesive tape.
3. To check whether the tube is in the stomach:
(1) Suction The end of the tube is connected to a syringe and suction is performed; if gastric juice is drawn out, it means that it has been inserted into the stomach.
(2) Listening A small amount of air is injected into the gastric tube with a syringe, and a stethoscope is placed in the stomach to auscultate; if there is a sound of air passing through the water, the tube is inserted into the stomach.
(3) Look at the end of the gastric tube placed in a bowl of water, there should be no gas escape, if there are bubbles continuously escaping and consistent with the breath, that is, mistakenly into the trachea.
4. After confirming that the gastric tube is in the stomach, fold the end of the gastric tube and wrap it with gauze, and hold it with a clip. Place it next to the patient's pillow.
Experience of gastric intubation
In our department, from July 1999 to October 2003, 402 cases were hospitalized for autonasal gastric intubation without one complication. It is reported as follows.
1 Clinical data
1.1 General data The 402 cases in this group consisted of 314 males and 88 females, aged 13-81 years. Disease types included 102 cases of gastric cancer, 68 cases of colon cancer, 18 cases of pancreatic cancer, 127 cases of acute upper gastrointestinal perforation, and 87 other cases.
1.2 Materials 16F disposable latex gastric tube was applied.2 Methods (1) According to the condition, patients were introduced to the purpose of operation, the process and the method of cooperation. (2) Depending on the condition, take the sitting position or lying position, insert the gastric tube 15cm through the nasal cavity, ask the patient to do a swallowing action, and the operator inserts the gastric tube into the esophagus along with his swallowing. (3) Ask the patient to swallow once every 30s, and feed the gastric tube 4cm each time until it is fed 45-55cm. (4) Let the patient take the left lateral position, with a 20ml syringe suction gastric contents, connected to the negative pressure suction device, tape fixation.
3 Experience
(1) Before the operation, we should do a good job of the patient's ideological work, so that it eliminates concerns, and explain the essentials of swallowing, in order to obtain cooperation. (2) The anatomical and physiological characteristics of the upper gastrointestinal tract are: usually the incisors are about 15cm from the pharynx, about 40cm from the cardia, and about 55-60cm from the fundus of the stomach. peristaltic waves travel down the esophagus at a rate of 2-4cm per second, and it takes about 9s for the peak of peristaltic waves to arrive at the esophagus end from the beginning of the adult's swallow to the end of the end of the swallow, and it takes about 9s for successive swallows to produce similar waves, but when the pharyngeal phase of the swallow is repeated rapidly, the esophagus stays in a diastolic state until the last swallow. diastolic state until after the last swallow when a contraction wave occurs. The lower gastroesophageal sphincter is innervated by sympathetic and vagal nerves. Based on the above anatomical features, the gastric tube should be inserted with the peristaltic movement of the esophagus, so that the gastric tube will not form a curvature. (3) If the gastric tube is inserted at 40 cm, resistance is encountered. The lower gastro-esophageal sphincter should be contracted, and the patient should be asked to take a deep breath. Do not force insertion, otherwise it is easy to cause cardia mucosal abrasion. (4) The depth of insertion of gastric tube should be good, 55cm is appropriate, too short can not drain out all the gastric contents, too long is not necessary. (5) The gastric tube is easy to adhere to the stomach wall, in the operation, if the stomach contents are not extracted, the gastric tube can be slightly lifted up or down, to avoid excessive force damage to the gastric mucosa.