Dang it! That's a question for Dr. Clove to answer~

The dispute between Auntie Qiong Yao and her stepchildren has been discussed on the Internet for a long time in the past few days, so Dr. Clove is not going to talk much about it! Today, Dr. Clove will take you through the cause of the incident from a professional point of view - thenasogastric tube。

First, what is a nasogastric tube?

There are some patients who, due to their serious condition or prolonged coma, are unable to eat in the normal way, but the body still needs essential food and nutrition to function, and this is when feeding is accomplished through a nasogastric tube.

Simply put, a nasogastric tube is a hose that is inserted through one of the patient's nostrils and passes through the pharynx, esophagus, and ultimately to the patient's stomach. Depending on the patient's needs, the doctor uses this tube to deliver fluids and provide energy to the patient's body.

In addition to delivering fluids to the patient, this tube can also draw out the excess stored inside the stomach, thus reducing the burden on the patient's stomach. From a clinical point of view, the whole process is not complicated.

What's it like to have a nasogastric tube inserted?

I think this is the issue that many people are most concerned about. Ms. Qiong Yao also said that she did not want to give her husband a nasogastric tube precisely because she wanted him to be able to leave with dignity and not suffer any more. So, what exactly is it like to have a nasogastric tube inserted and how painful is it?

During intubation

During the operation of inserting a nasogastric tube, if the patient is in an awake state, he needs to cooperate with the doctor to perform a swallowing action. When the tube passes through the pharynx, the patient will feel an obvious foreign body sensation, and this sensation will make the patient feel nauseous.

post-canal fixation

After the nasogastric tube is placed and secured, the patient may also feel that there is always something in the throat, but it becomes better with slow habituation.

A patient who is completely unresponsive to external stimuli will most likely be unresponsive to the placement of a nasogastric tube, and it is up to the family to decide whether or not they are comfortable with the patient having a tube in their nostrils. Then again, isn't that what the dispute is about?

(Otology Dr. Zhao Headline Q&A 2017-05-18) Nasogastric tube is a special flexible tube, which is inserted from one side of the nostril during operation, through the pharynx, and through the esophagus to the stomach. Nasogastric tube insertion is a very routine clinical operation technique and a basic operation technique that clinicians and nurses are required to master. For awake patients, there will be some pharyngeal or epigastric discomfort during and after the operation, but most of them belong to the tolerable range, and the pain is much less than that of gastroscopy. Nasogastric tube insertion is required in the following clinical situations.

1. Provide gastrointestinal nutrition for patients who cannot eat normally on their own. Feeding via nasogastric tube is called nasal feeding. Clinical common in some neurology after stroke ball paralysis swallowing difficulties or choking on water intake of patients, these patients have difficulty in independent feeding, easy to food accidentally inhaled into the trachea, resulting in choking, you need to nasogastric tube to assist feeding. In addition, for some various reasons caused by coma or the body is unusually weak critically ill patients, also often need to nasal feeding diet to maintain or strengthen the body nutrition. Usually, we believe that patients who can eat on their own should be encouraged to eat on their own; patients who cannot eat on their own and can feed gastrointestinal nutrition nasogastrically should try to eat nasogastrically; and those who cannot feed nasogastrically (cannot cooperate or cannot feed nasogastrically due to disease) should be considered to be fed intravenously. Gastrointestinal nutrition can maintain relatively normal peristaltic digestion and absorption of the gastrointestinal tract to a certain extent, which is more conducive to the stabilization of gastrointestinal bacterial flora of the patient and the rehabilitation in the later stage than intravenous nutrition. Whether nasal feeding is long-term or temporary depends on the patient's physical status. Some patients can be removed from the nasogastric tube after they have passed through the dangerous or acute phase of the disease, and their autonomous dietary status can be gradually restored. For some patients who are in a long-term coma or vegetative state, a long-term nasogastric diet may be required to ensure gastrointestinal nutrition. The nutrient solution for nasal feeding can be specially configured enteral nutrient solution or various mixed food suspensions made by family members. Nasogastric feeding can be continuously pumped in through the nasogastric tube or intermittently pushed in by a syringe, and the specific choice of nutrient solution and the various ways of giving it should be decided according to the will of the doctor and the state of the patient.

2、Patients need continuous gastrointestinal decompression because of some diseases, in order to reduce abdominal distension, abdominal pain and other symptoms, and to reduce further tissue damage caused by gastric juice secretion. Commonly used in acute pancreatitis, cholecystitis, pyloric obstruction, intestinal obstruction, etc. or after abdominal surgery.

3、Used to observe the gastric fluid situation and carry out gastric fluid testing, such as checking the PH value of gastric fluid and occult blood test. Commonly used in patients with suspected gastroesophageal reflux, patients with upper gastrointestinal bleeding. After patients with upper gastrointestinal bleeding are put down the gastric tube, the gastric fluid is aspirated, and it is visualized whether the active bleeding continues or not.

4. Giving drugs through gastric tube. Commonly used in the treatment of upper gastrointestinal bleeding, through the gastric tube local administration of hemostatic agents or vasoconstrictor drugs can achieve the purpose of hemostasis, mainly used in the treatment of upper gastrointestinal bleeding.

5. Gastric lavage treatment. It is mainly used for patients who are poisoned by oral drugs or poisons.

Mr. Qiongyao's case should belong to the first situation, the purpose of intubation is mainly for gastrointestinal nutrition, in general, with or without gastrostomy tube pain is relatively small, especially comatose patients, should not feel the pain, and gastrointestinal nutrition for the patient's later recovery is very important, most of the family members can accept. Because it is an invasive operation, there may be some complications, and it is usually carried out by signing an informed consent form after a doctor-patient conversation. Nasogastric nutrition can help many patients who are critically ill and unable to eat to overcome their difficulties, and may even be able to achieve full recovery later. Generally speaking, whether to insert a gastric tube or not is not because of how painful and uncomfortable this operation is and choose to insert or not, but by the patient's prognosis of the underlying disease is decided, and generally the doctor will have a detailed communication with the patient's condition.

What is the "disposable gastric tube" that is often used in clinical practice?

Because of the disease, in hospitals we often see patients who need to use nasal feeding, with the help of a gastric tube to take in nutrients.

In neurology, it is common in patients with swallowing difficulties in patients with bulbar palsy; in gastroenterology, it is common in patients with intestinal obstruction and severe pancreatitis; some patients with Alzheimer's disease or patients who cannot do it on their own will also be fed by nasal feeding.

One of the things we use is a disposable gastrostomy tube.

The so-called disposable gastric tube is a relatively common medical device, mainly through the method of nasal feeding, the gastric tube as a catheter to supplement the body's nutritional needs. It is widely used in the clinic, but you need to know some precautions when using the disposable gastric tube, such as following the doctor's instructions and configuring the enteral nutrition solution according to the needs of the condition, so as to meet the patient's physical needs.

Therefore, the quality requirements for gastric tube are relatively high, the material needs to be polyurethane or silicone material, or even a new patented product like (Yirendang) single-use multi-lumen gastric tube with exclusive bionic design, made of imported polymer material. Compared with the traditional gastric tube, it is comfortable to use, well tolerated, less irritation to the mucous membrane and digestive tract; good flexibility, stable performance, resistant to X-ray radiation, resistant to many kinds of acid and alkali corrosion, and can be placed for a long time.

Nasogastric tube is left in the esophagus, the original physiological environment of the patient's digestive tract is altered, which can lead to poor closure of the esophageal sphincter at the end of the esophagus, the airway is not smooth violent coughing and other stressful stimuli are likely to lead to complications such as esophageal reflux, and gastric fluids can be extracted through the gastric tube.

Why did you have to put in a stomach tube?

Indeed, gastric tubes are inserted for several purposes, which may be therapeutic on the one hand, for example, transgastric decompression to drain out the gastrointestinal contents tends to be more common in intestinal obstruction, liver and gallbladder disease, and so on.

On the other hand, for patients who cannot eat by mouth, beating meals from a gastric tube ensures that the patient consumes enough nutritious water and medication for an early recovery! So the purpose of inserting a gastric tube is to improve and treat the patient's condition!