Nursing measures for indwelling gastric tube

Patients with indwelling gastric tubes actually have a lot of care to take care of in the follow-up period. If they are not properly cared for, it will cause certain harm to their bodies. Nursing measures for indwelling gastric tubes generally include proper fixation, appropriate insertion length of the gastric tube, maintaining the patency of the gastric tube, and regular flushing.

Nursing points

AFix it properly to prevent it from being bent or falling out. A. To fix the gastric tube, white rubber tape should be applied to the tip of the nose and the tape should be changed every day.

B. The length of the gastric tube inserted should be appropriate, generally about 45-55cm for adults. If you suspect the gastric tube has come out, notify your doctor immediately. At this time, nasogastric feeding should be temporarily stopped and nasogastric feeding can only be continued after making sure that the gastric tube is in the stomach. [Note] Method to determine whether the gastric tube is in the stomach: Use a syringe to draw out the stomach contents from the gastric tube. Use a syringe to inflate the gastric tube and use a stethoscope to listen for the sound of air passing through water in the stomach. Insert the stomach tube into the water without escaping bubbles.

C. Keep the gastric tube open to prevent it from getting kinked. When moving or turning the patient, prevent the gastric tube from coming out or getting folded.

2. Ensure the patency of the gastric tube and flush and aspirate gastric juice regularly.

A. Rinse regularly, once every 4 hours. When flushing, you should choose a 5 or 10 ml syringe and use 3-5 ml of normal saline to flush the gastric tube according to the model of the gastric tube, surgical site, surgical method, etc. Be careful not to use too much force when rinsing. If there is resistance, do not force it forward to avoid damaging the stomach wall or anastomosis, causing bleeding or anastomotic fistula. If there is resistance during flushing, gastric juice should be withdrawn first. If gastric juice is withdrawn, it means the gastric tube is unobstructed and flushing can be continued. If gastric juice cannot be extracted or the flushing resistance is great, you should notify your doctor and receive timely treatment.

B. Aspirate gastric juice regularly according to the secretion of gastric juice, usually once every 4 hours. When aspirating gastric juice, the suction force should not be too great to avoid damaging the stomach wall and causing mucosal injury and bleeding.

3. Closely observe the color, nature, and amount of gastric juice and keep records.

A． Observe the color and properties of gastric juice: gastric juice is generally dark green in color (mixed with bile). If the color is bright red, it indicates bleeding in the stomach. If the color is brown, it indicates that there is old blood in the stomach. If there is a change in the color or properties of gastric juice, you should notify your doctor promptly and give appropriate treatment.

B. Accurately record the amount of gastric juice: If the amount of gastric juice is too much, you should notify your doctor and deal with it in time. Avoid causing water and electrolyte imbalance.

4. Gastric tube care

A. Clean your nasal cavity with a cotton swab dipped in water every day.

B. When changing the tape, wipe the facial skin clean before applying it again, and be careful not to apply it to the same part of the skin.

C. The exposed part of the nasogastric tube must be properly placed to avoid it from slipping.

D. Pay attention to the scale of the nasogastric tube every day. If it is dislocated, notify the medical staff to handle it.

E. Clean the mouth daily with a cotton swab; if the patient is conscious and cooperative, use a toothbrush to clean the mouth. Encourage patients to brush their teeth and rinse their mouths and develop good hygiene habits. Provide oral care to patients who are unable to take care of themselves or who are unconscious.

F. If the patient is unconscious or agitated and uncooperative, the nasogastric tube must be prevented from being pulled out. If necessary, the patient's hands can be properly restrained and protected.

5. Nasogastric feeding care:

A. Before nasogastric feeding, make sure that the tube is in the stomach and there are no symptoms of abdominal distension or gastric retention.

B. The nasogastric feeding volume should not exceed 200 ml each time. It should be reasonably allocated and the interval time should be set according to the total daily volume and the patient's digestion and absorption conditions. After nasogastric feeding, rinse the nasogastric tube with warm water and place it in place. Continuous nasogastric feeding should be evenly infused.

C. The temperature of nasogastric feeding should be appropriate, around 35℃. The temperature of the nasogastric feeding fluid should be the same as room temperature during continuous infusion. Overheating can easily burn the stomach wall mucosa, while overcooling can easily cause indigestion and diarrhea. Clean oral and nasal secretions promptly.

D. The amount of nasogastric feeding may be small at the beginning. After the patient adapts, gradually increase the amount and accurately record the amount of nasogastric feeding.

[Note]: 1) Flushing the gastric tube after esophageal surgery: Use a 10ml syringe to draw 3-5ml of normal saline and flush slowly. If there is resistance, draw back first. Drawing out gastric juice indicates that the gastric tube is unobstructed. If the flushing resistance is great or the gastric tube is dislocated, notify the doctor immediately.

2) Flushing of gastric tube after subtotal or total gastrectomy:

Use a 5ml syringe to draw out 1-2ml of normal saline. First draw back if gastric juice is drawn out, then slowly flush the gastric tube. After flushing, the saline solution should be removed. If the flushing resistance is great or the gastric tube is dislocated, notify the doctor immediately.

3) Flushing of gastric tube after colon and rectal surgery:

Use a 5-10ml syringe to draw out about 5ml of normal saline and rinse slowly. If flushing is not smooth, the position of the gastric tube can be adjusted appropriately.

4) Gastric tube flushing for patients with pyloric obstruction:

Patients who need gastric lavage should follow the doctor's orders and regularly give 200 ml of 3% saline to the gastric tube. After clamping the gastric tube for half an hour, use negative pressure suction to suck out the gastric contents. If you encounter resistance when flushing, flush with a little more force, but remember not to flush violently. If the gastric tube is blocked, notify the doctor in time to replace the tube.