Insertion of a gas tube. Gas tube. The purpose of its application. contraindications and possible complications

Target: remove gases from the intestines.

Indications: flatulence, intestinal atony, when setting laxative enemas.

Contraindications: intestinal bleeding, prolapse of the rectum, fissures in the anus, acute inflammatory or ulcerative processes in the colon and anus, malignant neoplasms of the rectum, bleeding hemorrhoids.

cook: sterile: vent tube, tray, spatula, gloves, petroleum jelly, oilcloth, diaper, dressing gown, apron, water vessel, napkins, toilet paper, screen, container with disinfectant solution, KBU.

Action algorithm:

1. Explain to the patient the course and purpose of the procedure, get his consent.

2. Fence off the patient with a screen (when performing the procedure in the ward), put on a gown, apron.

3. Place a vessel next to the patient on a chair (pour some water into the vessel), place an oilcloth under the patient's buttocks, and a diaper over it.

4. Place the patient on the left side or supine position with the legs bent at the knees.

5. Decontaminate hands at a hygienic level, put on gloves.

6. Lubricate the rounded end of the gas tube with petroleum jelly for 20 - 30 cm.

7. Bend the tube in the middle, hold the free end of the tube IV - m and V - m with the fingers of your right hand, and take the rounded end like a writing pen.

8. Spread the buttocks I and II with the fingers of your left hand, and with your right hand, carefully, with light rotational movements, insert the gas outlet tube into the anus, moving it into the rectum, first towards the navel 3-4 cm, and then parallel to the spine to a depth of 8-10 cm.

9. Turn the patient on his back or leave in the same position.

10. Dip the free end of the vent tube into a tray or vessel filled with water.

11. After making sure that the gases are escaping (by the bubbles in the water), remove the tray or vessel with water, and wrap the outer end of the gas outlet tube in a diaper in the form of an envelope.

12. Monitor the patient every 20 to 30 minutes.

13. Cover the patient, leave the tube in the intestine until the gas is completely discharged, but not more than 1 hour.

14. Gently remove the tube with rotational movements, treat the anus with a napkin or toilet paper and insert a napkin soaked in petroleum jelly between the buttocks.

15. Place the vent tube into the disinfectant container.

16. Remove gloves, place wipes, gloves in KBU.

Equipment: sterile vent tube, petroleum jelly, spatula, gloves, vessel, toilet paper, screen, oilcloth, diaper, waterproof bag.

Algorithm for performing manipulation:

1. Explain to the patient the purpose and course of the upcoming manipulation and obtain his consent.

2. Fence off the patient with a screen.

3. Put on gloves.

4. Help the patient lie closer to the edge of the bed on the left side with legs pressed to the stomach (if the patient is contraindicated in the position on the left side, the gas tube can be placed in the supine position).

5. Put an oilcloth under the buttocks of the patient, and a diaper on it.

6. Put a vessel on the diaper next to the patient (pour some water into the vessel).

Lubricate the rounded end of the tube with Vaseline for 20-30 cm.

8. Bend the tube, pinch the free end with 4 and 5 fingers, and take the rounded end as a handle.

9. Spread the buttocks, insert the gas outlet tube into the rectum to a depth of 20-30 cm.

10. Lower the free end of the tube into the vessel (the duration of the procedure is determined by the doctor).

11. Ensure the safety of the patient, cover with a blanket.

12. Remove gloves, wash and dry hands.

13. After 30-60 minutes. put on gloves, unfold the blanket, remove the tube and throw it into the waste container.

Wipe the patient's anus with toilet paper.

15. Remove the oilcloth and diaper, throw it into a waterproof bag.

16. Remove gloves.

17. Help the patient to take a comfortable position, cover him, remove the screen.

18. Wash your hands, dry.

Make an entry in the Medical record about the performed manipulation

Installation of a gas outlet pipe. Target. Removal of gases from the intestines.
Indications. Flatulence.
Contraindications. intestinal bleeding; bleeding tumor of the rectum; acute inflammation of the anus.
Equipment. A sterile gas outlet tube connected by means of a control glass to a rubber tube 30-50 cm long; petrolatum; a vessel with a small amount of water; oilcloth; diaper; rubber gloves; gauze napkin; zinc ointment; a container marked "For enema tips" with a 3% solution of chloramine.

Technique for setting a gas outlet tube.

1. An oilcloth and a diaper are placed under the patient.
2. The patient is laid on the left side with the legs bent at the knees and pulled up to the stomach. If the patient cannot turn on his side, then he remains lying on his back, legs bent at the knees and separated.
3. Lubricate the rounded end of the gas tube with petroleum jelly.
4. Putting on rubber gloves, spread the buttocks with the left hand, and with the right hand, taking the tube with a gauze napkin, insert it with rotational movements, observing all the bends of the rectum, to a depth of 20-25 cm. on the bed or, even better, at the bedside of the patient on a stool.
5. After 1.0 - 1.5 hours, the tube should be removed, even if there is no relief, in order to avoid the formation of bedsores on the wall of the rectum.
6. After removing the gas tube, the patient should be flushed. In case of reddening of the anus, it is lubricated with a drying ointment, such as zinc.
7. After use, the system is immediately soaked in a 3% solution of chloramine, then processed according to OST 42-21-2-85.

The gas outlet tube, as before, remains very popular. It has been used in medicine for many decades. The technique of setting a gas outlet tube has been known for a long time and has not changed since then. The main indication for its use is flatulence.

Contraindications to the use of a gas outlet tube are:

Cracks in the anus;
Acute inflammatory processes that occur in the colon and anus;
Ulcerative processes;
Malignant neoplasms in the rectum.

Gas venting is used, as a rule, if the enema cannot be performed. This may be preceded by various causes and diseases. When flatulence does not go away after the introduction of a special diet and taking certain drugs, surgical procedures are necessary. The tube is exactly what can help in such a situation..

Dimension specification

The length of the tube is about forty centimeters;
Diameter - from five to ten millimeters;
One end of the tube is expanded, the other is rounded;
Holes are located on the sides of the gas outlet.

Gas tube insertion technique

The procedure for setting up a gas outlet tube usually performed on children. Babies most often suffer from increased gas formation and flatulence. In order to do everything right and help the child cope with the problem, it is important to follow all the rules.

Required tools:

Petrolatum;
Putty knife;
Vessel;
Toilet paper;
Sterile gloves;
Absorbent diaper;
Clean sheet.

Preparing to run the algorithm:

These steps will help you prepare as best as possible for the procedure. The introduction of a gas outlet should not cause discomfort. If the child feels that he is uncomfortable, you need to start the procedure again..

Performing a procedure

It is necessary to push the baby's buttocks and insert the gas outlet tube into the rectum to a depth of up to ten centimeters;

Lower the free end of the device into a nearby vessel;

Cover the patient if the doctor has prescribed a long procedure.

Young children are not usually prescribed long-term insertion of a gas tube. As soon as the procedure begins, they get rid of the gases that torment them and feel much better. When the intestines return to normal and get rid of excess air, you need to carefully remove the gas outlet tube.

It is important to remember that;

Indications:

· Flatulence.

Contraindications:

Equipment:

Sterile gas outlet tube with a diameter of 3-5 mm and a length of 15-30 cm (children of early and preschool age); 30 - 50 cm (for schoolchildren).

· Capacity with water (for control of an otkhozhdeniye of gases).

· Containers with disinfectant solution for disinfection of the changing table and used equipment.

Sterile cotton balls, sterile tweezers and scissors, alcohol.

· Diapers, gloves, waterproof decontaminated apron.

Action algorithm:

1. In the absence of a chair, 20-30 minutes before the procedure, make a cleansing enema.

2. Wash and dry your hands, put on gloves and an apron, wash your hands again,

3. Treat the changing table with a disinfectant solution twice with an interval of 15 minutes.

4. Wash your hands, cover the table with a diaper. Two diapers are placed under the child's pelvis: the end of the gas outlet tube is inserted into the first one, the child is dried with the other diaper after washing.

5. Unwrap the baby, leaving it in a vest and a flannel blouse. Lay it on the changing table. At the age of up to 6 months, the child is placed on the back, after 6 months - on the left side with the legs brought to the stomach (the assistant holds the child in this position).

6. Remove the gas outlet tube from the sterile bag, lubricate the end with sterile vegetable oil.

7. Spread the buttocks with the left hand (for a small child in the “lying on the back” position, raise the legs with the left hand - when working without an assistant; or the assistant holds the legs), with the right hand with rotational movements without effort, directing the end of the tube first to the navel (in the position of the child " lying on the back "anteriorly and upwards), and then, after passing the external and internal anal sphincters, somewhat backwards, parallel to the coccyx, insert the gas outlet tube:

Infants - 5 - 8 cm

From 1 year to 3 years - by 8 - 10 cm

From 3 to 7 years - by 10 - 15 cm

Older children - by 20 - 30 cm

8. Lead the outer end of the gas outlet tube into a tray with water, bubbles should appear when gases escape. For young children, bring the end of the gas outlet tube into a loosely crumpled diaper.

9. Carry out a circular massage of the abdomen in a clockwise direction. Cover baby with a sheet to prevent chills.

10. Leave the vent tube in the intestine for 30 - 60 minutes, less often it is left for a longer time, up to several hours.

11. Remove the gas outlet tube, wash and dry the skin, lubricate the perianal area with sterile vegetable oil. Lower the gas outlet tube into a container with a disinfectant solution, put gloves into another container, and treat the apron with a disinfectant solution. Wash the hands.

If necessary, the manipulation can be repeated after 3-4 hours.

Cleansing enema.

Indications:

Coprostasis (absence of stool in children under one year old - within 36 hours, older - 48 hours).

Poisoning (food, medicinal, poisons).

food allergies.

Before medicinal enemas.

Preparation for endoscopic examination (rectoscopy, colonoscopy).

Preparation for x-ray examination of the stomach, intestines, kidneys.

Preparation for ultrasound examination of the abdominal organs.

Preparation for surgical interventions.

Contraindications:

· Inflammatory changes in the lower part of the colon.

· Gastrointestinal bleeding.

· Acute inflammatory and ulcerative processes in the anus, anal fissures.

Prolapse of the rectal mucosa.

Suspicion of appendicitis.

Equipment:

· Sterile rubber balloon with a soft tip (children under 5 years old), children over 5 years old - a balloon with a hard tip or Esmarch's mug and a hard tip.

· Boiled water.

· Sterile vegetable oil, sterile cotton balls.

· A container with a disinfectant solution for disinfecting the changing table.

· A container with a disinfectant solution for disinfecting a used canister.

· Diapers.

Action algorithm:

1. Wash your hands, put on gloves, wash your hands again.

2. Treat the changing table or couch with disinfectant, wash your hands.

3. Cover the changing table with a diaper.

4. Remove a sterile canister from a sterile package, hold it with your right hand with the tip up (the tip is located between the index and middle fingers, the thumb rests on the bottom).

5. Release the air from the balloon by squeezing it with your thumb, lower the tip into the water and collect the liquid. Then release the remaining air from the balloon (until liquid appears in the tip) and draw liquid again.

6. Lubricate the tip with vegetable oil.

7. Lay the child (at the age of up to 6 months - on his back, raising his legs; older - on his left side with legs bent and brought to the stomach. The assistant holds the child). Place 2-3 diapers folded several times under the pelvis.

8. Stand comfortably near the child, spread the buttocks with the left hand, and with the right rotational movements, as if in a spiral, without effort, insert the tip first towards the navel (in the position of the child on the back - up and forward), passing the external and internal sphincters of the anus - backwards, parallel to the coccyx. The tip is inserted to a depth of 3-5 cm in children under 5 years of age and 6-8 cm in children over 5 years of age. When working without an assistant, hold the torso of the child with the left forearm, and the legs bent at the knees with the left hand.

9. Slowly squeezing the balloon, inject the liquid, without opening the balloon, withdraw the tip, while squeezing the buttocks with your left hand, hold them for 2-3 minutes.

10. Lower the can into a container with a disinfectant solution.

11. The child lies on the changing table for 8-10 minutes, until the urge to defecate appears, put a diaper on the perineal area.

12. Defecation of a child of the 1st year of life - lying on a changing table in diapers, an older child is planted on a potty.

13. Wash the child, dry the skin, dress. Put dirty diapers in a bag.

Medicinal enema.

Indications:

For local action in inflammatory processes in the colon.

· For the general impact - the introduction of drugs.

Contraindications:

· Inflammatory changes in the lower part of the colon.

· Gastrointestinal bleeding.

· Acute inflammatory and ulcerative processes in the anus, anal fissures.

Prolapse of the rectal mucosa.

Equipment:

· Sterile gas outlet tube.

· Medicine:

A) no more than 15 - 30 ml. children under one year old.

B) no more than 50 ml for older children.

· Pot with hot water.

Sterile syringe (20 ml or 50 ml).

· Containers with disinfectant solutions.

· Sterile vegetable oil.

· Diapers.

Action algorithm:

Medicinal enema is carried out immediately after the natural act of defecation or after the action of a previously made cleansing enema.

1. Warm up the drug to 37 - 38 degrees.

2. Wash your hands, put on gloves, treat the changing table with disinfectant, wash your hands, cover the table with a diaper.

3. Lay the child on his left side with legs bent and brought to the stomach, put 2-3 diapers folded several times under the pelvis. A child under the age of 6 months is laid on his back.

4. Draw up the drug in a sterile syringe.

5. Remove the gas outlet tube from the sterile bag, pour sterile vegetable oil over its end.

6. With the left hand, spread the buttocks, and with the right rotational movements, as if in a spiral, without effort, insert the gas outlet tube first towards the navel (in the position of the child on the back - upwards and anteriorly), passing the external and internal sphincters of the anus - backwards to a depth:

A) children up to a year - 5 - 8 cm,

B) from 1 to 3 years - 8 - 10 cm,

C) from 3 to 7 years - 10 - 15 cm,

D) older children - 20 - 30 cm.

7. Connect the gas outlet tube to the syringe and slowly, in portions, inject the drug.

8. Remove the syringe, squeeze the outer end of the vent tube with your fingers, draw air into the syringe and, reconnecting it to the vent tube, introduce air into the tube to push the drug from the tube into the intestine.

9. Remove the gas tube while squeezing the buttocks with the fingers of your left hand.

10. Turn the child on his stomach and hold him in this position for 10 minutes.

11. Lower the gas outlet tube into a container with a disinfectant solution, rinse it with a syringe, draw a disinfectant solution into it, lower the disassembled syringe there. Remove gloves and dip into another container with disinfectant.

Siphon enema.

Indications:

Coprostasis (with the ineffectiveness of a cleansing enema).

Poisoning by medicinal, chemical or vegetable poisons.

Suspicion of dynamic intestinal obstruction.

Contraindications:

· Appendicitis, peritonitis. Inflammatory changes in the lower part of the colon.

· Gastrointestinal bleeding.

· Acute inflammatory and ulcerative processes in the anus, anal fissures.

Prolapse of the rectal mucosa.

The first days after surgery on the abdominal organs.

Equipment:

· Sterile rubber tube with a diameter of 8 - 10 mm, length 1.5 m.

· Rubber tip 20 - 30 cm long.

· Funnel.

· A jug with 2% sodium bicarbonate solution or a slightly pink solution of potassium permanganate at a temperature of 36 - 37 degrees.

Liquid volume in ml:

Up to 6 months – 800 – 1000

6 - 12 months - 1000 - 1500

2 - 5 years - 2000 - 5000

6 - 10 years - 5000 - 6000

Senior - 8000

Containers with disinfectants.

Action algorithm:

1. Wash your hands, put on gloves and wash your hands again.

2. Treat the changing table or couch with disinfectant, wash your hands and cover the table with a diaper.

3. Lay the child on the left side with the legs brought to the stomach and bent at the knees.

4. Remove the sterile tube, tip, funnel.

5. Put a tip on the end of the tube, lubricate it with petroleum jelly or vegetable oil.

6. Spread the buttocks with the left hand, with the right hand, without effort, insert the tip 20-30 cm into the rectum (the tip is first directed anteriorly to the navel, after passing the sphincters of the anus, it turns backward, parallel to the coccyx).

7. Put a funnel on the free end of the tube.

8. Fill the funnel with liquid from the jug and raise it to a height of 50 - 60 cm above the changing table (or above the couch).

9. When the liquid reaches the neck of the funnel, lower the latter below the level of the couch (changing table), pouring the wash water with feces into the basin

10. Fill the funnel with clean liquid and raise again. Repeat the procedure up to 10 times until clean wash water is obtained.

Gastric lavage.

Indications:

Food and drug poisoning, chemical and vegetable poisons.

Vomiting with intestinal toxicosis with exsicosis.

Diagnostic examination of washing water (for identification of poison, cytological examination, isolation of pathogens of tuberculosis of the respiratory organs and intestinal infections.

Contraindications:

Long-term (more than 2 hours) periods of poisoning with caustic substances (risk of perforation of the esophagus and stomach).

· Convulsions.

Significant narrowing of the esophagus.

· Cardiovascular insufficiency.

Peptic ulcer in the acute stage.

Possible complications:

· Aspiration of wash water. (Observe the technique of performing manipulation, control the condition of the child).

· Cerebral edema. (In order to prevent water-salt disorders, use saline solutions for the procedure).

· Traumatic damage to the mucous membranes of the esophagus and stomach. (Introduce the probe without effort).

· Cooling the baby. (The washing liquid is heated to 35 - 37 degrees).

Equipment:

· Sterile gastric tube.

· Sterile 20 gram syringe or sterile funnel.

· Tray or basin for draining wash water.

Gastric lavage solution (2% sodium bicarbonate solution, slightly pink potassium permanganate solution, isotonic potassium chloride solution, Ringer's solution, Hemodez, water with the addition of salt - take 1 tablespoon of salt and sodium bicarbonate for 3 liters of water) temperature 35 - 37 degrees.

Age: Approximate fluid volume:

Up to 1 month 200 ml

1 – 3 months 500 ml

3 – 12 months 1000 ml

2-3 - years 2000 - 3000 ml

3 - 6 years 3000 - 5000 ml

7 - 10 years 6000 - 8000 ml

Over 10 years old 10000 ml

Sterile jar.

Sterile gloves.

· Sterile vegetable oil.

· Sterile tweezers.

Containers with disinfectant solution for disinfecting the changing table
used tools, gloves.

· Diapers.

Action algorithm:

1. Wash your hands. Treat the changing table with disinfectant, cover it with a diaper.

2. Swaddle a young child.

3. Children of early age and seniors in a serious condition are laid on their side with their faces slightly turned down. If the condition allows, the assistant sits the elders on his knees, holding his legs with his crossed legs, fixes his head with one hand by the forehead, and clasps his hands with the other. An unconscious child is intubated before the procedure.

4. Check the sterile packaging with a gastric tube for leaks, check the expiration date, treat the cut edge with alcohol, cut the edge with sterile scissors.

5. Put on sterile gloves.

6. Remove the probe from the bag, take its rounded end with a hole on the side wall between the thumb and forefinger, fix the opposite end between 4 and 5 fingers, the assistant pours sterile vegetable oil on the end of the probe.

7. Measure with a probe (without touching the child) the distance from the bridge of the nose to the navel, mark it with a sterile bandage.

8. Insert the probe through the lower nasal passage into the stomach, lower its free end into the tray.

Note: if the probe mistakenly hits the larynx, the child begins to cough and choke. The probe is removed and inserted again.

9. Put a syringe on the free end of the probe and, pulling the piston, remove the contents of the stomach, place a small amount of it in a sterile jar (for bacteriological examination).

10. Using a syringe, inject liquid for washing into the stomach, then, pulling the piston, remove it from the stomach, release it into the tray. It is impossible to allow the complete transition of all liquid from the syringe, because. after the liquid, air is sucked in, which makes it difficult to remove the contents of the stomach in the future.

11. Washing continues until clean wash water.

Note: if the amount of fluid removed is less than the amount injected, insert the probe deeper or pull it higher (in the first case, the probe does not reach the bottom of the stomach, in the second case, the probe is inserted too deep and the fluid enters the intestine).

12. Remove the probe from the stomach, lower it into a container with disinfectant, rinse with a syringe and fill it with disinfectant, lower the disassembled syringe there.

13. Remove gloves, lower into another container with disinfectant.

14. Pour washing water with dry bleach at the rate of 200 g per 1 liter. , after 1 hour, pour into the sewer.

For children older than 2 years, the manipulation is carried out in the “sitting” position. The probe is inserted through the mouth. During washing, it is necessary to control the condition of the child. Residual contents and gastric lavages should be carefully examined, especially if gastric bleeding is suspected. After the procedure, the next feeding should be skipped.