RU2365386C1 - Sokolov's method of nasogastric probe insertion - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, can be used for insertion of a nasogastric probe without participation of the patient. An endotracheal single pass tube locating its top extremity on distance 2-4 cm from labiums of the patient is entered into an esophagus through a mouth. A nasogastric probe is inserted into a stomach through the endotracheal tube channel. Holding a probe, the endotracheal tube is taken out from an esophagus. Thus the tube is moved along the probe. A drop system tube fragment not less than 50 cm in length is entered into pharynx on depth of approximately 15-20 cm through a nasal course. A mouth opener is entered. The bottom extremity of a tube fragment is withdrawn through a nasal passage. The top extremity of the nasogastric probe and the bottom extremity of the tube fragment are densely bridged "end-to-end" to formation of a loop near patient's labiums. Simultaneously influencing in one direction on a loop and the external extremity of a tube fragment, smooth insertion of the bridged extremities in a mouth is carried out. Moving to a nasopharynx and withdrawal of the bridged extremities through a nasal passage outside is carried out. A tube fragment is separated from the nasogastric probe after withdrawal of the bridged extremities.

EFFECT: possibility of the guaranteed hit of a nasogastric probe in a stomach, elimination of probe twisting in a throat, depression of possibility of pharynx and nose mucosas traumatising, possibility to insert a probe to unconscious patients.

Description

The invention relates to medicine, in particular to methods of introducing a nasogastric tube without the participation of a patient in an unconscious state.

A known method of introducing a nasogastric probe, which consists in introducing the probe through the nasal passage (see, for example, the book "Basic Nursing Procedures", author Rita Tobler, M., "Medicine", 2004, p. 101-106).

The disadvantage of this method is the complexity, and sometimes the impossibility of its implementation in relation to patients in an unconscious state (including under general anesthesia) and not having the ability to promote the promotion of the probe by swallowing. With the introduction of the probe to such patients, a number of difficulties arise, in particular the need to conduct the probe through the first physiological narrowing at the junction of the lower part of the pharynx into the esophagus. At the same time, the nasogastric tube may not have enough rigidity for passage into the esophagus, and its preliminary freezing does not give the desired effect, because during installation, the probe quickly defrosts. Using a flexible metal introducer inside the probe increases the risk of soft tissue perforation. In addition, in such patients, the first physiological narrowing of the esophagus may be even greater due to a displacement of the entrance to the esophagus caused by an installed endotracheal tube, the inflated cuff of which exerts a slight pressure on the esophagus.

The invention solves the problem of simplifying the method of introducing a nasogastric tube and creating the possibility of its guaranteed introduction to patients in an unconscious state.

The essence of the method consists in the fact that successively injected through the mouth into the esophagus to a depth of approximately 26-28 cm, an endotracheal single-lumen tube (without a conductor and with a cuff open) with the lower end located in the esophagus at a depth of at least 10-12 cm from the entrance into the esophagus, and the upper end of the tube at a distance of approximately 2-4 cm from the patient's lips; through the channel of the endotracheal tube, a thin nasogastric tube is inserted into the stomach (with a cannula previously cut off if necessary); holding the probe, remove the endotracheal tube from the esophagus, moving it around the probe; through the lower nasal passage enter into the pharynx (to a depth of approximately 15-20 cm) a fragment of a tube of a drip system, at least 50 cm long, with the lower pre-fused end forward; a rotary expander is introduced; bring the lower end of the tube fragment through the mouth to the outside; the upper end of the nasogastric tube and the lower end of the tube fragment tightly connect “end to end” with the formation of a loop at the lips of the patient; at the same time, acting in one direction on the loop and the outer end of the tube fragment, they smoothly insert the connected ends into the mouth, move them in the nasopharynx and bring them out through the nasal passage with a gradual decrease and nullification of the loop; after the connected ends exit the nasal passage, the tube fragment is separated from the nasogastric tube.

The method provides the possibility of introducing a nasogastric tube to patients with impaired consciousness or under general anesthesia, because allows the probe through the channel of the previously inserted endotracheal tube to undergo a physiological narrowing at the point where the lower part of the pharynx passes into the esophagus.

The method is as follows.

If the patient is in an unconscious state, but not under general anesthesia, the following procedures must first be performed.

45 minutes before the introduction of the nasogastric tube, it is necessary to carry out the usual premedication of atropine sulfate and to empty the stomach using a thick gastric tube, which is then removed. The use of a gastric tube for insertion of a thin tube is undesirable since in this case, the end of the thick probe must be cut off, which will reduce the rigidity of the probe, and therefore make it difficult to get into the esophagus. In addition, the sharp edges of the cut can damage the mucous membrane of the pharynx and pear-shaped pockets.

Then, before the introduction of the endotracheal tube to relax the masticatory muscles, intravenous sodium thiapental 3-5 mg / kg (or more, depending on the patient's tolerance to anesthesia drugs) can be administered. It is possible to use local anesthesia (for example, a spray of 10% lidocaine), as well as a laryngoscope.

If the patient is under general anesthesia, the above procedures are not performed (because they should already be performed).

The process of introducing a nasogastric tube begins with the fact that a lubricated endotracheal single-lumen tube (for example, a Murphy tube with a diameter of 0.7-0.9 cm, a length of 32 cm with an open cuff, but without a conductor), is introduced (using the so-called manual memory of the doctor) through the patient’s mouth into the esophagus to a depth of approximately 26-28 cm, so that its upper end is located at a distance from the patient’s lips, approximately 2-4 cm (in this case, the lower end of the tube will be located at a distance not less than its 10-12 cm from its entrance). If necessary, you can use a rotary expander.

After that, a lubricated thin nasogastric tube through the channel of the endotracheal tube is easily inserted into the esophagus and further into the stomach. In this case, the upper end of the probe is located at a distance of approximately 64-78 cm from the patient’s lips (this distance is equal to the difference between the length of the nasogastric tube of approximately 120 cm and the sum of the distance from the patient’s incisors to the entrance to the stomach (37-41 cm) and the length of the tip of the probe in the stomach (5-15 cm), i.e. the sum of 42-56 cm). During administration, the probe does not have the ability to twist in the throat and is guaranteed to enter the patient’s stomach.

Then, holding the probe, the endotracheal tube is removed from the esophagus and pharynx along the probe, as if on a guide. If the size of the probe cannula is larger than the diameter of the endotracheal tube, then the cannula is cut off before the tube is removed.

After that, through the nasal passage into the throat is inserted (to a depth of approximately 15-20 cm) a fragment of a tube of a drip system, at least 50 cm long, previously fused and lubricated with the lower end forward.

Then, to prevent injury to the doctor’s fingers, it is necessary to install a conservator. The conclusion of the lower end of the tube fragment through the mouth to the outside is done by the doctor with the middle and index fingers, which must be inserted into the patient's throat and by which this end is captured. This process can be carried out using anatomical tweezers (as well as a forceps or Billroth type clamp), for which it is necessary to use a directional light source.

The ends of the nasogastric tube and tube fragment are tightly connected to each other by the type of "end to end" (with an overlap of about 1 cm), forming a loop near the patient's mouth. Then the doctor simultaneously and in one direction, acting with one hand on the loop and the other on the outer end of the tube fragment (pulling it out), gently inserts the connected ends into the patient’s mouth, moves them in the nasopharynx, and out through the nasal passage (the loop decreases in size and disappears). To prevent separation of the ends of the probe and the tube, sharp movements must be avoided and the forces applied to the probe and tube to be equal with the left and right hands. After separation of the ends of the nasogastric tube and a fragment of the tube of the drip system, the probe is installed through the nasal passage not from the outside, but from the inside.

After installing the nasogastric tube, its position is checked in the usual way and fixed.

Using the method has the following advantages:

provides the possibility of guaranteed entry of the nasogastric probe into the stomach, eliminates the possibility of twisting the probe in the patient’s pharynx, reduces the possibility of injury to the mucous membranes of the pharynx and nose, and increases the convenience of installing the probe in unconscious patients.

In addition, if the anesthesiologist is faced with the task of installing a nasogastric tube during endotracheal anesthesia or total intravenous anesthesia with mechanical ventilation - issues with anesthesia and muscle relaxation, gastric emptying have already been resolved. If the patient is on prolonged mechanical ventilation, then issues with anesthesia, relaxation and emptying of the stomach are resolved depending on the patient's condition.

Claims (1)

The method of introducing a nasogastric tube, which consists in introducing the probe through the nasal passage, characterized in that the endotracheal single-lumen tube is inserted sequentially through the mouth into the esophagus with the location of its upper end at a distance of 2-4 cm from the patient’s lips, a nasogastric tube is inserted through the endotracheal tube holding the probe, the endotracheal tube is removed from the esophagus, moving it along the probe, through the nasal passage, a fragment of a tube of a drip system of at least at least 15-20 cm in length is inserted into the pharynx e 50 cm, a rotary expander is introduced, the lower end of the tube fragment is brought out through the mouth outward, the upper end of the nasogastric tube and the lower end of the tube fragment are tightly connected “end to end” to form a loop near the patient’s lips, simultaneously acting in one direction on the loop and the outer end of the fragment tube, smoothly insert the connected ends into the mouth, move in the nasopharynx and bring them out through the nasal passage, after the exit of the connected ends, the tube fragment is separated from the nasogastric tube.