A general Practitioner may be required to insert a nasogastric tue, (more commonly termed as a Ryle’s tube) I) to give stomach wash in a case of poisoning as immediate first aid or II) for feeding a unconscious or semiconscious patient at home. Technique:
Take a Ryle’s Tube No.16, Lubricate its tip with liquid paraffin or xylocaine jelly. (Patient comfort can be increased by giving xylocaine liquid to swallow 5 minutes before the procedure.)
Inspect the nostrils, and select the nostril which is more roomy.
fix the head with left hand over the forehead, turn the tip of the nose slightly upwards, and very gently, introduce the tube – into the nostril, vertically i.e. along the floor of the nose (it should be pointing below the level of the ears.)
you will first feel a small resistance or the tube touching the posterior pharyngeal wall and turning downwards introduce it for another 1”, till the tip comes to lie at the upper end of oesphagus.
Now stop her for a moment, and let the patent relax. Ask him to breath through open mouth.
Then ask the patient to swallow saliva, and exactly when the larynx moves up, push the tube forwards into the esophagus.
-if the patient coughs (usually violently), withdraw the tube immediately. It had entered the trachea. Let the bout of cough subside, and then try again. -If the patient gags excessively, tell him to open the mouth and inspect the throat. If the tube has ruled into the pharynx & mouth, withdraw it and try again.
Once the tube has entered the oesophagus, push it steadily ahead, (no need to ask the patient to make swallowing movements now.) till the first Black mark on the tube is crossed, and stomach contents start flowing out Generally the tube is advanced upto the second mark.
After confirming that the tip of the tube lies in the stomach, fix the tube with a ½ cm wide adhesive tube 2 times & ending on the other nostril or check.
Confirmation of tube position in stomach: It is very important to be 100% sure that the tube is in the stomach, particularly when you are going to feed the patient through it and more particularly, when the patient is not fully conscious – when the tube may enter the trachea, without elicting cough reflex.
Aspirate the tube with a 200c syringe. Aspiration of stomach contents confirms position.
Auscultate over the left side of epigastrium. Now inject 10cc air through the Ryle’s tube with a syringe. Auscultation of a bubling sound over the stomach is confirmatory.
If in doubt, dip the outer tip of Ryle’s tube in a bowl of water. Airblast with each expiration suggests that the tube is in trachea.
Ryle’s Tube feeding:Never feed a patient through the Ryle’s tube, unless the position of its tip in stomach is confirmed. Attach a funnel or a 20/50cc syringe barrel to the open end & pour the liquids to be given. Let the liquids run into the stomach by gravity. Thicker liquids may have to be pushed with the syringe. Feed 100 to 200cc every 2 hrs. Aspirate before each fee, to confirm that previous feeds have moved into the intestine, and stomach is empty (very important in unconscious & bedridden patients who may vomit large quantities and aspirate)After every feed, flush the Ryle’s tube with water to avoid clogging. Then occlude the tube. Feeds that may be given: Milk-plain or with Protein supplements, All soups, Electrolyte solutions, Readymade preparations like Recupex, fruit juices.Stomach Wash: In poisoning, it is vitally important to wash out the poison, as fast as possible. So introduce the largest available Ryle’s tube – like No. 22 or 24. Push in clean water or dilute Potassium Permanganate solution – 200 to 300 ml at a time- very rapidly into the stomach, and let it flow out. Repeat this till returning fluid is absolutely clear. Don’t forget to collect the first sample in a bottle and sent it with the patient to the hospital where you will refer him for further treatment.
