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▲ Feed water, medicine or milk by nasogastric tube.
(Photo provided / Luo Yanyu)
Text / Luo Yanyu
The 75-year-old Mr. Huang suddenly became slurred when he was having dinner with his family. He was unable to hold the bowl with his left hand.
In the emergency room, the emergency physician consulted with the neurologist and initiated the acute treatment process for stroke. The specialist nurse then assessed the patient's swallowing ability and found that he would choke on water. Therefore, he discussed with the physician and his family about the placement of a nasogastric tube. need.
Mr. Huang's daughter burst into tears on the spot. She didn't expect it to be so serious that it would require "intubation" treatment?
The nurse explained patiently: "This is a nasogastric tube! It is not an endotracheal intubation that is used to give oxygen to open the airway in emergency. The nasogastric tube is a flexible tube that is placed from the nasal cavity through the esophagus to the stomach. The total length is about 50 cm. , in order to give medicines and nutrients, otherwise the current coughing situation is directly fed from the mouth, it is easy to cause aspiration pneumonia.”
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Although Ms. Huang agreed, she still didn't understand, until she watched the specialist nurse neatly insert the soft nasogastric tube along the nasal passage, and asked Mr. Huang to swallow the saliva according to the feeling, without using two The nasogastric tube was put in place within minutes, and she was relieved, realizing that the nasogastric tube was not scary at all.
▲ Place a nasogastric tube.
(Photo provided / Luo Yanyu)
Give liquid nutrition or drugs directly
Nasogastric tube is actually just a flexible tube. For patients who have difficulty swallowing or are unconscious and unable to eat, this tube can be used to directly lead to the stomach to give liquid nutrition or medicine.
During the period of acute stroke, the patient may not only suffer from hemiplegia, but also affect the muscle strength or coordination of swallowing. Especially clear water is more likely to choke into the trachea and lungs than thick and blocky food. Oral feeding may be more dangerous in the absence of clear or cough reflex.
Because the bacteria of aspiration pneumonia will be mixed with multiple flora in the oral cavity, it is different from the pneumonia bacteria commonly infected in the community, and it is more difficult to treat. It has always been an important acute complication of stroke.
Patients may be disabled by hemiplegia, but aspiration pneumonia can be fatal, so precautions must be taken.
▲Fed water, medicine or milk by nasogastric tube; the patient in the picture is not the subject of this article.
(Photo provided / Luo Yanyu)
It is very different from "endotracheal intubation"
Although we also call it "nasogastric tube insertion", it is quite different from "endotracheal intubation" for emergency establishment of airway patency and oxygen supply.
The process of endotracheal intubation is quite dangerous, often requiring sedatives or muscle relaxants, full oxygen supply by the side, and a ventilator on standby. In an emergency, it may even cause local injuries to the throat.
The use of nasogastric tube in the acute stage of stroke is based on the swallowing function of the patient. After the acute stage, many patients can recover from the use of nasogastric tube while recovering some of their muscle strength through rehabilitation and recuperation. It doesn't necessarily mean "unable to remove the tube".
However, the action of placing the nasogastric tube needs to be auscultated to ensure that the tube is going to the stomach instead of entering the trachea. It needs to be performed by a qualified physician or specialist nurse, and it is not suitable for family members to place it by themselves.
If an acute stroke requires a nasogastric tube to give nutrition and drugs, we must understand that this is to reduce the "necessary evil" of aspiration pneumonia. Don't mistake it for tracheal intubation and give up the opportunity for treatment.
(The author is the Director of Department of Neurology, Hualien Tzu Chi Hospital)
Medical Dictionary:
Nasogastric tube (nasogastric tube), referred to as NG in the hospital term, enters from the nostril, passes through the throat and reaches the transparent plastic tube of the stomach. The total length of the tube into the stomach is about 50-60 cm. The tube is provided with a clear liquid diet, and the drug can also be administered with water after grinding to avoid choking into the trachea and causing aspiration pneumonia.
Usually, when placing, a water-soluble lubricant is applied to the tube wall to reduce the discomfort caused by friction during the process, and auscultation is used to confirm that the stomach is in the correct position and not strayed into the trachea.
(Text/Luo Yanyu)
▲A specialist nurse placed a nasogastric tube for the patient under the supervision of a physician; the patient in the picture is not the subject of this article.
(Photo provided / Luo Yanyu)
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