确定胃管置入位置困难患者的综合判断措施

Synthetic identification of difficult nasogastric tube insertions

目的探讨常规方法无法明确判断胃管置入位置时的应对措施和技巧。方法对184例次留置胃管患者,首先应用抽取胃液法、听气过水声法及气泡逸出法进行常规判断,其中64例置入位置判定困难者再采取观察气泡逸出规律法、结合插管深度和体会插管顺畅性、触诊法、试注生理盐水法及延迟判断法进行判定。结果64例均获得正确判断,未发生一例置管意外;184例次置胃管者,167例次一次置管成功。结论采取上述应对措施,解决了临床上难以确定胃管位置的复杂问题,提高了一次置管成功率,减少患者重复置管的痛苦。

Objective To explore measures and techniques solving difficult nasogastric tube insertions when position of the tube tip is unable to identify. Methods For 184 difficult nasogastric tube insertions, we first attempted to identify the position of the tip by drawing gastric contents, listening through the stethoscope while we slowly pushed the air into the nasogastric tube, and by watc- hing for air bubbles. Then for 64 cases, we moved on to try out the methods of watching for air bubbles, checking the insertion depth, fat-homing the smoothness or not during insertion, making palpipation, and injecting normal saline. Results We correctly i- dentified the position of the tube tip in the 64 cases. No accidents occurred during insertion. Among 184 difficult nasogastric tube in- sertions, 167 insertions were successfully completed at the first attempt. Conclusion By taking the above mentioned measures, we are able to identify the position of the tube tip, improve success rate of the the first insertion attempt, and avoid suffering of patients from tube placement.