Thursday, July 15, 2004

Where Tubes Can Go OR The First Thing That Made Me Want To Throw Up In Nursing School

This week we learned about nasogastric (NG) tubes. These are long, flexible rubber or plastic catheters that go in your nose, down your throat and into your stomach or intestine. They're inserted so that you can put food directly into someone's stomach if they can't swallow, have just had stomach surgery etc. The insertion of a NG tube is a pretty crude procedure: you stick a rubber tube in someone's nose, ask them to swallow and shove said tube down their throat, wait for their gag reflex to calm down and then continue shoving the tube down until it reaches the stomach.

How do you know you've reached the stomach? Well, until recently, the nurse would simply eyeball the tube length and insert as much tubing as he or she thought was necessary. However, this did not ensure that the NG tube ended up where it was supposed to. Two years ago, however, a nurse inserted a tube into someone's BRAIN and the person died after their cerebrum was soaked with the equivalent of SlimFast. The patient had had palate surgery so the tube went straight through their nose to their brain cavity and since you have no nerves on your brain no one knew until the patient was DEAD. Tubes could also end up in people's lungs or other undesirable locations. Therefore, they now require an X-ray to check the placement of the tube before any food is administered.

NG tubes have the ignominious designation as the first thing in nursing school that made me want to vomit: before you feed someone through a NG tube, you aspirate (pull back on a syringe) the tube to check the stomach's contents. If most cases, you will only be able to pull out a couple of teaspoons-worth of hydrochloric acid and partially-digested food (yes, now that you mention it: puke). However, if a person's intestines are not working fast enough, you will end up aspirating several syringefuls of stomach contents. This means that you have to pull up one syringeful of stomach contents, empty it out in basin and continue to pull up stomach contents until you've emptied the stomach. When the stomach is empty, the good nurse is supposed to measure the amount of puke in the basin and then PUT IT BACK IN THE PATIENT. For whatever, reason, I find this absolutely disgusting. The idea of drawing up puke, letting it sit around for a while and then feeding it back to a patient via a tube in their nose is just too much for me. I was sitting in the lecture hall trying not to gag. It was terrible.

In happier news, I've been given a reprieve for the fall semester and do not have to take biostatistics. This means I get to take an elective. The choices are v. exciting: Spanish for Health Professionals, Forensic Nursing, Breastfeeding, Patient Education....

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