GASTROCLYSIS: WHAT IT CONSISTS OF, COMPLICATIONS AND CARE - MEDICINE - 2024

The gastroclisis is a procedure designed to feed enterally (digestive tract) people who for medical reasons can not eat by mouth. It applies to people with serious neurological conditions such as CVA (cerebrovascular accident), cerebral infarction, amyotrophic lateral sclerosis or patients with advanced Alzheimer's.

Likewise, it may be necessary to feed patients using gastroclysis in cases of head and neck cancer, esophageal surgery, jaw fractures that require cerclage, neck trauma that involves the digestive tract and even in cases of esophageal and gastric tumors that block the transit of food through the digestive tract.

What does it consist of?

Gastroclysis consists of placing a feeding tube through the nose and into the stomach. For this, special long tubes known as Levine tubes are used, which are designed to remain in the upper digestive tract for a long time.

Although they can be placed blind, most of the time they are performed under fluoroscopy; that is, under continuous X-ray images (like a film) in order to guarantee that the tip of the probe reaches the stomach or even further, to the duodenum, when the clinical condition of the patient requires it.

Once in situ, the administration of enteral preparations can be started through the feeding tube.

Since the first stage of digestion (chewing and insalivation) is omitted through this feeding route, and considering that solid foods could obstruct the tube, in general, special preparations of liquid to liquid-dense consistency are chosen.

Types of preparations that can be administered

When the tip of the probe is in the stomach, you can opt for foods of a liquid consistency such as soups, juices, milk and even some clear smoothies, since the administered food will reach the stomach and there will begin a more digestion process or less normal.

However, when for some condition the tip of the probe must advance to the duodenum (as in cases of stomach cancer and pancreatic head cancer), it is no longer possible to administer this type of food because the second stage of the digestion (gastric) is also bypassed.

In these cases, a series of special preparations known as enteral diet must be administered, which consists of a food preparation made up of macromolecules of glucose, lipids and amino acids.

As the case may be, it is very important that the nutritionist calculate both the caloric intake and the administration schedule.

Administration options

Feeding by gastroclysis can be done in two ways: continuous drip or bolus.

Continuous drip

The continuous drip consists of the administration of the gastroclysis food continuously, drop by drop over 6 to 8 hours, after which the preparation is changed for a new one.

The goal is for the patient to receive a continuous supply of calories and nutrients without overloading the digestive tract or metabolism.

This type of scheme is often used in very seriously ill patients, especially those hospitalized in intensive care wards.

Bowling administration

This is the most physiological administration scheme, since it resembles the way in which humans usually eat.

With this scheme, between 3 and 5 feeding sessions are planned per day during which a quantity defined by the nutritionist is administered through the feeding tube, both calories and liquids.

Each feeding session usually lasts between half an hour and 45 minutes, during which the patient receives all the calories he needs to sustain himself until the next feeding session.

It is very important that with the bolus scheme the administration of food is fast enough to complete the feeding session in the expected time, but slow enough to avoid gastric dilation, since this would cause nausea and even vomiting.

Administration technique

Continuous administration protocol

When it comes to continuous administration there are no major drawbacks. Once the tube has been placed and its position verified by radiology, the patency can be verified by passing water, then connecting the feeding bag to the free end and adjusting the drip.

From then on, all that remains is to verify that the food passes through the tube and change the bags of feeding preparations at regular intervals, taking care to wash the tube with water each time it is changed to avoid obstruction.

It is a simple procedure that is generally carried out by nurses, since as previously mentioned, this administration scheme is usually reserved for critically ill patients.

Bolus administration protocol

In the cases of administration in boluses - which is usually the technique of choice, especially when the patient is discharged - things get a bit complicated. However, following the following protocol you should have no problem feeding a patient at home via gastroclysis.

- Handwashing.

- Prepare the food using suitable utensils for it.

- Serve the portion that corresponds.

- Wash the free end of the probe with water and a clean cloth.

- Using a 30 cc syringe, pass water at room temperature through the probe to verify permeability. If there is resistance, try to overcome it by exerting gentle pressure; if not possible, consult a doctor.

- If the tube is permeable, proceed with the administration of food using the 30 cc syringe, taking the portion of food with it and then instilling it little by little through the tube.

- Repeat the operation until completing the portion of food.

- At the end, wash the probe again using water at room temperature and the 30 cc syringe.

- The patient must remain seated or semi-seated for at least 30 minutes after the food has been administered.

- Clean the free end of the feeding tube to ensure it is free of food debris.

Complications

The complications of gastroclysis can be of three types: those related to the placement of the tube, those derived from the permanence of the tube and those associated with the feeding process.

Complications related to tube placement

- When placing the probe there is a risk of injury to the structures of the nose and turbinates.

- The patient may vomit and breathe in; therefore it is best to perform the procedure on an empty stomach.

- There may be a case of a false path; that is, the probe "goes through" solid tissue during placement, opening a new extra anatomical path instead of following the natural path.

- Although it is rare, it may be the case of esophageal or gastric perforation, especially if there is a history of peptic ulcer.

- There is a risk that the tube will reach the respiratory tract instead of the digestive tract. In this case, the patient will present a cough and shortness of breath; however, depending on the degree of physical deterioration, there may be no clinical manifestations.

From the above, the importance of X-ray verification of the position of the probe is concluded. At this point, it should be emphasized that no substance will ever be administered through the feeding tube until it is 100% sure that the inner end is in the stomach or duodenum.

Complications derived from the permanence of the probe

- The most common is erosion of the nasal mucosa and even the skin of the wing of the nose, especially when it comes to permanent and long-term probes.

- Some patients complain of throat discomfort and even nausea.

- The risk of obstruction is always present, especially if the probe is not washed regularly. When this happens, sometimes the only possible solution is to change the tube.

Complications associated with the feeding process

- They usually appear when there are failures in the administration technique, especially a very fast infusion.

- Patients may experience nausea, vomiting or hiccups due to acute gastric dilatation. It is particularly important to note that vomiting in these cases is very dangerous, since there is a risk of aspiration.

- Feeding due to gastroclysis may be associated with metabolic complications such as hypoglycemia (if the administration is delayed longer than prescribed) and hyperglycemia (very fast administration or with an inadequate concentration of nutrients, particularly carbohydrates).

- In some cases, diarrhea and abdominal distension may occur, especially when the tube must be placed in the duodenum. This is because the high osmotic load of the food induces an osmotic-type diarrhea.

Care

Gastroclysis care is basic and if observed routinely, every day, the patient should not have any complications. These cares include:

- Cleaning the free end of the tube before and after each feeding session or changing the nutritional preparation bag.

- Washing of the nasogastric tube with water at room temperature- This should be before and after each feeding session or change of nutritional preparation bag.

- Alternate the fixation site of the free end of the probe (to one side, to the other, on the forehead) to avoid erosion in the wing of the nose.

- Keep the area where the tube comes out through the nose clean and dry. If necessary, special dressings should be used for this purpose.

- If there is resistance when passing water or food, try to overcome it with moderate pressure; if this is not easy, consult a doctor.

- Avoid pulling or pushing the probe to a different position from the one it is in. If necessary, fix with medical adhesive so that the patient does not tear it off.

References

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