After laryngectomy, there are three aspects to understand about nasogastric feeding nutrition!

Author: Liu Yongling, deputy chief nurse, Beijing Tongren Hospital, Capital Medical University

Reviewer: Wang Lixiang, Chief Physician, Third Medical Center, PLA General Hospital

The 10th Chairman of the Science Popularization Branch of the Chinese Medical Association

Laryngeal cancer patients need to use a gastric tube to provide nutrition for a period of time after laryngectomy.

How to care for the gastric tube? How to properly feed through the nasogastric tube? How to achieve nutritional balance through nasogastric feeding? These are all issues that the family members of laryngectomy patients need to understand carefully.

1. How to care for the gastric tube after laryngeal cancer patients are discharged from the hospital after surgery?

First, check the firmness of the fixation. There are two ways to fix it: one is to tie a rope, fix the rope on the sleeve, and then tie it to the back of the head. In addition, many hospitals now use adhesive plaster to fix it on the nose. Regardless of the method, we must check its firmness regularly to prevent it from falling out. In addition, when the patient is active at night or sleeping, we must also prevent the gastric tube from being pulled out.

Second, pay attention to the depth of the cannula. We have a little trick, which is to make a small mark on the nasogastric tube, that is, draw a small print, because with chewing and swallowing, the nasogastric tube will move up and down. In order to prevent the nasogastric tube from shifting, or to be able to understand it immediately after it shifts, we make a small mark, which is quite effective.

Third, be careful to prevent the stomach tube from being blocked. In order to make the food richer, many family members will try to put as much food as possible through the stomach tube, but be careful not to put in too sticky food. Before and after nasogastric feeding, 50-100 ml of warm water should be used to thoroughly flush the tube to ensure that the stomach tube will not be blocked. If blockage occurs, the stomach tube is mainly unblocked by back suction. If the back suction resistance is particularly large and there is no other way to clear the tube, the stomach tube may need to be reset.

If there is no blockage, the gastric tube should be replaced once a month if conditions permit. Because food needs to be fed in here every day, there is a concern about the growth of bacteria. Many patients have different food, so the color of the gastric tube will change, some will turn yellow, some will turn white, so the gastric tube usage specification requires that it be replaced once a month.

Figure 1 Original copyright image, no permission to reprint

2. How should patients with laryngeal cancer receive correct nasogastric feeding after being discharged from the hospital after surgery?

Correct nasogastric feeding diet involves four dimensions, namely concentration, temperature, angle and speed.

Concentration: Uniform.

Temperature: 38℃-41℃ is the most suitable. We need to try it, for example, family members can taste it to see if the temperature is appropriate. In addition, we can also apply the homogenized meal to the inside of the wrist, because the skin on the inside of the wrist is more sensitive, to see if the temperature is hot. If not, we can give the patient a meal at this temperature.

Angle: The angle actually refers to the appropriate lying position for the patient when giving nasogastric feeding. Under normal circumstances, we half-rock the bed, sitting or semi-sitting, basically 30-45 degrees, which is also conducive to the smooth entry of nasogastric feeding food. In addition, after each feeding, the patient should maintain this posture for 30-45 minutes to promote the digestion of food. If the patient lies down quickly, the food that has been fed may reflux up, which will have a certain impact on the local wound and may also cause aspiration pneumonia, so this angle problem should also be paid attention to.

Speed: When we are feeding food, we must not do it too fast, otherwise it will cause stomach discomfort to the patient. In principle, 100 ml should be fed to the patient in about 8-10 minutes. How much should the patient eat in a day? Most of them are fed 4-6 times a day, about once every 3 hours during the day. According to the patient's personal situation, young patients may eat more, and elderly patients may eat less. Generally, each time is about 250-350 ml, and the body needs about 2500 ml a day, depending on the individual's body needs.

In addition, before feeding, there is a routine step, which is to first draw back the stomach contents with a gastric tube. We call this checking the residual volume in the stomach. If 150 ml is easily drawn out, it means that the food from the last feeding has not been digested, or the patient's digestive ability is relatively weak that day. In this case, do not feed the patient too much. You can reduce the amount of each feeding or extend the interval time.

Figure 2 Original copyright image, no permission to reprint

Of course, we also need to consider whether the patient has been less active recently. If this is the case, we need to increase the patient's activity level. If there is still a lot of residual food in the stomach and digestion is not good, we can give some digestive enzymes or drugs to increase gastric motility.

In addition, there is one more thing to remind everyone. When preparing homogenized meals for patients, be careful to avoid large particles of food as much as possible to avoid tube blockage. If you make a homogenized meal at home and do not eat it on the same day, do not eat it the next day. The homogenized meal for the next day must be made again.

3. How can laryngeal cancer patients achieve nutritional balance through nasogastric feeding after being discharged from the hospital after surgery?

The most common diet in the hospital is homogenized meal. If the patient is at home, this method is also recommended. It can also increase protein intake because the increase in protein can repair cells well and promote wound healing.

The preparation of homogenized meal mainly includes, for example, rice, vegetables, protein, sugar, olive oil, and 5-6 grams of salt.

Protein can be two eggs, or lean meat, such as beef, pork, chicken, liver, fish, or duck. Vegetables can also be diversified. For example, carrots are usually the main food, but they can be replaced with cabbage or cauliflower.

Each food should be carefully cleaned, cooked, put into a grinder, add 1000 ml of water, and then stir, basically it can reach a volume of about 1800 ml. Generally, patients are used to eating three or four times a day, divided into 3-4 equal portions, and put in the refrigerator for freshness. Water and juice can also be added in the middle of each homogenized meal. If the patient's stomach function is not very good and often has acid reflux, it is recommended to consume less sweet juice.

We also need to remind everyone that if you are a diabetic, the amount of rice and sugar added will generally be reduced by half. It used to be 50 grams, but now it can be reduced to 25 grams. Other matching foods can continue to be eaten, including protein and vegetables.

In addition, if you are a diabetic, it is not recommended to drink fruit juice between meals. You can replace it with vegetable juice or plain water.