Medical summary paper model essay: gastric tube indwelling method and nursing model essay: gastric tube indwelling method and nursing purpose: summarize the methods and nursing of indwelling gastric tube for different patients, expound the selection and insertion depth of gastric tube, the prevention and nursing of complications, and put forward that appropriate methods and nursing should be selected according to the patient's situation. Methods: Summarize. Conclusion: Different patients have different gastric tube selection, intubation methods and nursing care. Keywords indwelling gastric tube nursing indwelling gastric tube is widely used in clinic, which is often used for nutritional support and gastrointestinal decompression. Nasal feeding through stomach tube is one of the main methods to provide nutrition, heat and gastric perfusion to coma patients or patients who can't take food orally, and to promote patients' recovery. You can also know the nature and quantity of gastric juice by sucking, and observe whether the patient has digestive tract complications. Effective gastrointestinal decompression can reduce gastrointestinal pressure, relieve abdominal distension, promote wound healing, improve blood circulation of gastrointestinal wall and promote the recovery of digestive function. For gastrointestinal and biliary tract surgery, indwelling gastric tube before operation can also effectively reduce the complications during anesthesia and after operation, which is extremely important for postoperative recovery. In recent years, due to the diversification of clinical diseases and the development requirements of holistic nursing, the method and nursing of indwelling gastric tube have also developed accordingly. In order to meet this need, the methods and nursing care of indwelling gastric tube were summarized through extensive collection of information. 1 Method of indwelling gastric tube 1. 1 Selection and improvement of gastric tube The silicone gastric tube has gradually replaced the traditional rubber gastric tube with its advantages of good histocompatibility, transparent wall, soft wall and large lateral holes. Clinically, most adults use 14~28 silica gel gastric tube, but the most commonly used one is 16. Newborns often choose No.6 gastric tube. To solve the coma problem. The difficulty of intubation in critically ill patients has been studied [1]. There is also a gastric tube [2] with a three-way valve to prevent the injection from overflowing; Dropping the medicine into the gastric tube at one time can spray the liquid medicine all over the gastric mucosa to achieve the therapeutic purpose [3]; Some people also use scalp needles instead of stomach tubes to give nasal feeding to newborns, which can not only drip milk or liquid medicine, but also reduce the damage to children's mucosa. At present, a new type of gastric tube has been introduced in China, which is soft, thin, corrosion-resistant and has a guide wire. The tube can be placed for 90 days to 180 days, which is more suitable for elderly patients with coma and poor swallowing reflex. 1.2 gastric tube insertion method 1.2.l neonatal gastric tube insertion method is difficult because of imperfect swallowing and cough reflex. In the process of intubation, when the stomach tube goes down to 5cm~7cm (that is, when it reaches the pharynx), the assistant quickly dips a little sugar water or milk into the child's mouth with a sterile cotton swab to make him suck. At this time, the operator quickly inserts the gastric tube down into the stomach. Sun Yan and others believe that neonatal nasal stenosis will cause congestion and edema of nasal mucosa, decrease the cross-sectional area of nasal cavity, increase nasal resistance, and affect lung function, while oral indwelling gastric tube has little effect on children [5]. 1.2.2 Methods of urethral catheterization for children above preschool age. At this stage, the child is over three years old and can cooperate with the oral saline method. When the gastric tube reaches the pharynx, the assistant feeds the child with normal saline with a spoon and inserts the gastric tube into the stomach while feeding; For children who are unconscious and crying, a simple mouth opening method can be used: the child lies on his back and his head is fixed backwards; Take out the piston of 5ml syringe, cut off the nipple and root, trim the cut surface to make it smooth, wrap it with sterile gauze, insert it into the mouth to the root of the tongue, the assistant fixes the handle of the outer tube of the mouth, and the operator sends the gastric tube into the stomach along the inner wall of the syringe [6]. This method can alleviate the pain of children and improve the success rate of intubation. 1.2.3 routine preparation for adult catheterization: lubricate the front end of the gastric tube with liquid paraffin gauze 15cm~20cm, clamp the gastric tube with gauze and clamp the front end of the gastric tube with tweezers, and insert it along one nostril. When the stomach tube passes through the throat (14cm~ 16cm), ask. However, this method is easy to cause nausea and vomiting, which will lead to intubation failure. Therefore, reducing the stimulation to the superior laryngeal nerve is the key to success. The method of inserting stomach tube with drinking water (same as above) can distract patients' attention, relieve their nervousness and reduce the irritation of stomach tube to throat. Through swallowing reflex, the stomach tube can easily enter the esophagus, and it is not easy to get into the trachea by mistake, but it is forbidden for comatose patients with digestive tract perforation, intestinal obstruction, abdominal pain with unknown diagnosis, abdominal trauma and no swallowing reflex. For awake sensitive person, it is suggested that swallowing 20ml~30ml paraffin oil during intubation can not only produce swallowing action, but also make paraffin oil adhere to esophagus and gastric mucosa, reducing the friction and irritation of gastric tube to mucosa [7]. Some people also put forward the anesthesia lubrication method, that is, spraying or dripping L% dicaine before intubation, and then intubation when there is numbness, which can also reduce the patient's stimulus reflex [8]. Tang Mei and others also believe that compared with the traditional rapid gastric tube insertion method, the slow gastric tube insertion method has higher one-time success rate, better patient tolerance and less adverse reactions. That is, ask the patient's adverse reactions at any time during intubation, and adjust the intubation speed according to the patient's reaction. The intubation speed is consistent with the patient's swallowing action, and it slows down or stops when passing through the nasal cavity, throat and esophageal stenosis. Tell the patient to take a deep breath, try not to cough, and at the same time comfort the patient to relax. Slowly insert the gastric tube into the stomach, and the whole time should not exceed 20S. All patients should take a semi-supine position during intubation [9]. 1.2.4 urethral catheterization for special patients 1.2.4. 1 lateral position tube method for comatose patients [10]: It is suitable for coma, acute cerebral hemorrhage, stiff neck, and people whose heads are not suitable for activities. When intubation, the patient lies on his side, the operator faces the patient and slowly inserts the gastric tube through one nostril. This method does not depend on the patient's swallowing and avoids moving the head. ② Mandibular intubation [1 1]: used for patients with deep coma and drooping tongue. When the stomach tube is inserted into the oropharynx, another person holds the patient's jaw with both hands, so that his head is in a backward state, lifts the lingual muscle, and then inserts the stomach tube into the stomach. ③ Fast insertion of gastric tube with double pillows [12]: Suitable for coma patients. Place the double pillows directly under the patient's head so that the mandible is as close to the sternal stalk as possible. Pass the gastric tube through the nasal cavity according to the conventional method, and insert the gastric tube with both hands alternately and quickly. At the same time, the hands are slightly twisted in the same direction to increase the toughness of the gastric tube, so that the end of the gastric tube slides into the stomach along the posterior wall of the esophagus, but it is forbidden for patients with brain stem injury. 1.2.4.2 patients with mechanical ventilation ① tracheotomy patients indirectly press the esophageal wall due to the pushing effect of metal catheter on the inner wall of trachea. When gastric tube insertion 16cm~ 18cm reaches epiglottis, it will be coiled in the mouth to prevent resistance. When the catheter reaches the tracheotomy site 2cm~3cm below the pharynx, the assistant can gently pull out the tracheal intubation. The operator inserts the gastric tube downwards, and after passing through the tracheotomy site, the assistant puts the tracheal intubation back to its original position, and then continues to insert the gastric tube according to the conventional method, which can reduce the indirect pressure on the esophageal wall [13]. ② For patients with tracheotomy, the gas in the balloon can be emptied first, and then 2~6ml gas is injected into the balloon to make it full; Patients take a low semi-recumbent position or look up 10 ~ 30. When the operator slowly sends the gastric tube through the nostril for 6~8cm, lift the occipital part to make the mandible cling to the intubation to prevent the gastric tube from entering the trachea by mistake. When the gastric tube is blocked, he can inject 2~5ml of 2% lidocaine into the gastric tube and stay for 1 ~ 3min, so that the liquid medicine can fully infiltrate the throat and esophageal mucosa. ③ For comatose patients or delirious patients with pulmonary encephalopathy who are connected to the ventilator through tracheal intubation, children's tracheal intubation is used as a guide tube. First, the guide tube is placed in the esophagus through the nasal cavity, and then the gastric tube is introduced into the stomach through the guide tube. 1.2.4.3 patients with esophageal stenosis can be treated by endoscopic intervention. After inserting gastroscope into esophagus to observe esophageal stenosis, dilate the stenosis for 5min~ 10min with dilator. After inserting the guide wire into the biopsy port of the endoscope, pull out the endoscope, send it into the stomach along the guide wire, and pull out the guide wire to fix the gastric tube [15]. 1.3 indwelling length The conventional length of indwelling gastric tube is earlobe-tip of nose-xiphoid process, but through clinical observation, it is found that this depth is only in the cardia or body, and sometimes the lateral hole is in the esophagus outside the cardia. If gastrointestinal decompression is performed, it is difficult to suck out stomach contents, and nasal feeding will aggravate ischemic necrosis of esophageal mucosa. Some people have improved the method of measuring the body surface between eyebrows and umbilicus, and found that the gastric tube can reach the gastric antrum through many clinical experiments, thus effectively carrying out gastrointestinal decompression or enteral nutrition. Lin Li [16] also thinks that the traditional insertion depth is 55cm~68cm, and 10cm~ 13cm should be added. 1.4 inspection of indwelling gastric tube According to basic nursing, three inspection methods are introduced, that is, putting clear water at the opening of gastric tube to see if there are bubbles, extracting gastric juice and listening to breathing sounds, or using PH test paper for inspection. The results will be more accurate, and the PH value of gastric juice is 1.5~3. Hu Yumei thinks that after inserting the gastric tube, drink 1~2 spoons of water with a spoon or straw, and the gastric tube is connected with the negative pressure box. After 2 ~ 4 minutes, it can be observed that there is no water sucked out of the stomach tube, so it can be judged whether it is in the stomach. This method is convenient and can also be used to check whether the gastric tube is unobstructed, which is easy for patients to accept. 2 Nursing care of indwelling gastric tube 2. 1 General nursing 2. 1 Nursing patients before intubation are most likely to be nervous and afraid. In view of patients' psychological problems, supportive psychotherapy was used for nursing intervention. Clean the nasal cavity before intubation and observe whether there are polyps, tumors, congestion, edema, stenosis, etc. And ask if there is any hemorrhagic disease. If any abnormality is found, report it to the doctor immediately, and take corresponding measures to treat the symptoms. 2. 1.2 Nursing during intubation encourages patients to enhance their confidence and stimulate their initiative. If you encounter resistance during intubation, don't insert it forcibly, and find out the reason, especially for patients with esophageal and cardiac cancer. If there is a lump in the lumen, air can be injected into the stomach tube. If burping occurs, it means that the opening of the lumen is in the esophagus, and the stomach tube can be inserted downward. 2. 1.3 Nursing patients should stay awake with patients after intubation. Turn over regularly and massage back, shoulders and neck; Rinse your mouth regularly with mouthwash and wipe your lips, apply lip balm such as glycerin to relieve thirst and dry your lips; Rinse the stomach tube with normal saline or warm boiled water for about 30~50ml every day, and observe the color, quality and quantity of drainage fluid. During gastrointestinal decompression, fasting and water prohibition are required. When drugs need to be injected, the tube should be clamped for 30 minutes after injection to avoid sucking out drugs and affecting the curative effect. Dry throat and sore throat can be rinsed with cold boiled water. If it is difficult to expectorate, let them take a deep breath every day to prevent lung complications.

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