the deviants' dictionary Briefing Updated 18 July 1996

Nasogastric Tubes by Bob Newquist

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Contents:

• Introduction
• What to Use
• Ways to Play
  • Insertion Procedure
  • What to do when the tube is in
• Precautions and Dangers

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Suitable tubes are available from medical suppliers. The easiest ones to use are the old-fashioned, rather more rigid PVC tubes; in modern medical practise, softer tubes are preferred for patient comfort but are more difficult to insert, requiring the use of a wire guide, and for SM patient comfort may not be such a pressing issue.

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The procedure for insertion and use of nasogastric tubes can be found in any introductory nursing manual, and it's recommended that you consult such a source before contemplating such play.

First, measure the tube so you know how far you have to go (tip of the nose to the spot between the eyebrows, plus the distance from the opening of the ear down to just below the xyphoid process, plus a few cm for extra margin of safety). Lube the first 10 cm with a water soluble lubricant like K-Y or Lubifax, pick a nose hole and insert slowly. Check to make sure that it arrived where you intended -- the easiest and safest way is to blow air into it with a bulb syringe while listening to the person's stomach with a stethoscope for the telltale gurgles.

To remove, just pull at a moderate rate until it is out. The procedure is unpleasant but not particularly painful.

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You now have control over one of the basic functions of the human body, ingestion. Anything with a fairly low viscosity that humans safely ingest can be used: water, puréed and watered down solid foods, fresh urine etc. Be careful with quantities -- bear in mind how much one may comfortably eat or drink at a normal sitting and at least halve that. If you give alcohol, make sure there is specific agreement for this and give with care and in great moderation. Avoid spirits, and let anything sparkling, like beer or champagne, stand for an hour or so to let the gas evaporate.

You can use a basting syringe. Fill it with liquid, place the tip in the NG, take off the bulb and let gravity empty it into their stomach. Once you have filled them up, you can reverse the process. Use the basting syringe to draw fluid from the stomach, then lower the NG below the level of the stomach, remove the syringe from the NG and let gravity syphon it of into a bucket.

For a real head trip, catheterise the person and hook a tube between the catheter and the NG. This should not be maintained for more than two or three 'recycles' to prevent the concentration of urea.

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Once you know what to do, how to do it, and have been supervised doing it, the activity would fall into the low-moderate risk range. If you don't know what you are doing, it becomes a fairly high risk procedure. If there is any way possible, have someone teach you; a less desirable option is to practise on yourself a few times.

The following particular precautions should be observed:

• Never use force. If at the bend where the nasal passages dive toward the pharynx you have to push much pressure at all, it's too hard. There is a blockage there. Try the other nosehole, or stop.
• Realize that the procedure will break a few capillaries under the most ideal of circumstances. Don't use the tube on more than one person. If you reuse the tube on the same person, make sure it is clean on the inside by flushing with water for 20 minutes or more.
• The tube may go into the lungs. On a conscious, unimpaired person, this is not a big risk. Always check to make sure the NG is properly in place. If the patient can talk, it's not in the lungs. But is it in the stomach?
• Aspiration pneumonia. Not likely with a water based lubricant. If an oil based lube is used and the person breathes some into their lungs, that person will develop a pneumonia and it will be very difficult to treat.
• Small tears to the mucosa of the nose, pharynx and eosophagus. Not a danger really. On the skin they would be called abrasions, but the person might blow small clots out of their nose the next day.
• Gagging heavily and vomiting is fairly common. Of course, with vomiting comes the danger of inhaling at the wrong time. To get around this, most nurses have the patient tilt their head as far down toward their chest as possible. This forces the epiglottis to an almost closed position and reduces the possibility of the NG going into the lungs or of aspiring vomit. Alternatively, while the head is down on the chest, have the patient drink water through a straw. They will have to fight the gag reflex, but this has the elegance of helping to draw the tube into the stomach.

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