No more worries about having a long nose (Part 2) - Home care for nasogastric tubes

This is the 4604th article of Da Yi Xiao Hu

Nasogastric tube feeding is also known as "nasogastric feeding". In the previous article, we introduced the home "feeding" care of nasogastric tubes, but how to place this "long nose" and how to manage it? Let us continue to introduce relevant professional nursing knowledge to help everyone.

How to manage this "long nose" in daily life?

The nasogastric tube is the only way for the patient to take in food, so its care is extremely important and is mainly divided into two processes: fixation and cleaning.

1. Fixation

1. To clean the nose, you can use alcohol gauze or wet wipes to remove dirt on the face and both sides of the nose.

2. Cut the nose patch into a "human" shape and fix it on the nostril on the same side, press tightly, and spirally fix it 0.5cm away from the nasal cavity on the right side of the bifurcated end. Fold the end back about 0.3-0.5cm. Spirally fix it on the left side of the bifurcated end, and fold the end back about 0.3-0.5cm to facilitate loosening the adhesive patch when replacing it.

3. Reserve a certain length of nasogastric tube on the cheek on the same side to keep it in the appropriate position, avoiding being too long or too short, which may cause the tube to be pulled or slipped, increasing the patient's discomfort.

4. The face is fixed in a "U-shape" using the high-lift platform method to ensure that the gastric tube will not fall out or get folded, and at the same time will not affect the normal movement of the patient's head.

5. A label can be attached to the distal end of the gastric tube to mark the retention time and length, and the pressure on the skin and mucosa at the fixation site can be evaluated every day. (See the figure below for fixation method)

2. Flushing

1. Flush the tube with 20-30ml of warm water in a pulse manner before and after each feeding.

2. When feeding continuously, the tube should be flushed in a pulse manner with 20-30 ml of warm boiled water every 4 hours.

3. Before and after each administration, use 20-30ml of warm water to pulse-flush the tube.

4. For patients with impaired immune function or critically ill patients, sterile water for injection should be used to flush the tube.

5. Avoid mixing highly acidic liquid medicines (pH ≤ 5) with nutrient solution. (See the figure below for the pulse flushing technique)

What should I do if Long Nose feels uncomfortable after feeding?

In the process of daily nasogastric feeding, you often encounter some discomfort. If you encounter it, don't be nervous. You can solve it with the following methods:

1. Gastric retention

Generally, a syringe of ≥50ml can be used to extract gastric contents to assess gastric residual volume. When the gastric residual volume is >200ml, observe for any discomfort symptoms such as nausea, vomiting, diarrhea, abnormal bowel sounds, etc. If discomfort occurs, feeding should be slowed down or suspended, and the feeding plan can be adjusted or gastrointestinal motility drugs can be used. When the gastric residual volume is >500ml, consider suspending feeding.

2. Diarrhea

Observe the frequency of diarrhea, color, quality and quantity of stool; if the nutrient solution is infused too quickly, slow down the speed and use an infusion pump to control it; if the temperature of the nutrient solution is too low, use a heater.

3. Nausea and vomiting

Slowing down the infusion rate may assist with right lateral decubitus position.

4. Aspiration

Stop feeding immediately and find out the cause of aspiration; encourage the patient to cough and take a semi-recumbent position with the head tilted to one side; observe vital signs closely.

5. Gastric tube obstruction

Use 20-30ml warm water to pulse-flush the stomach tube; if it is ineffective, use 20-30ml of 5% sodium bicarbonate solution to flush the stomach tube. If none of the above works, seek medical attention immediately.

If you experience severe discomfort while feeding, try to stop feeding and contact your doctor immediately.

The above is the home care for nasogastric tube. With this knowledge, you no longer have to worry about having nowhere to put your "long nose" or having difficulty "eating".

In recent years, home care has become a new direction for the medical industry model. Through the professional guidance of nurses and the cooperation of patients and their families, patients can operate at home with peace of mind, saving time and energy, so that everyone can still receive comprehensive care after discharge from the hospital.

Written by: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Xu Yan, head nurse of the Department of Gastroenterology

Department of Gastroenterology, Chief Nurse Zhao Xinxin

Photo taken by: Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Nurse Xu Yan from the Department of Gastroenterology

Nurse Shen Ru from the Department of Gastroenterology