ACUTE ABDOMINAL PAIN - Medicine for Mountaineering and Other Wilderness Activities - page 289

from the person's nose to the stomach (which should have been previously measured
and marked) has been inserted.
4. After the tube is in place, a small amount of air should be injected through it with a
large syringe or bulb syringe. If the tube is in the stomach, bubbling sounds made by
the injected air can be clearly heard by listening over the stomach with a stethoscope.
If the tube has coiled in the back of the person's throat or turned on itself in the eso-
phagus and has not entered the stomach, such sounds are not heard, and the tube must
be partially withdrawn and reinserted.
5. Rarely, the tube may enter the trachea, causing the individual to cough and sometimes
to be unable to talk. If the tube is withdrawn promptly, no harm is done, but the person
may be understandably reluctant to undergo further attempts at intubation.
Figure 20-5. Apparatus for applying gentle suction to a nasogastric tube
6. After the tube is in place, it should be taped to the person's nose or forehead to prevent
itsbeingexpelledorswallowedentirely.Airandfluidinthestomachcanbewithdrawn
with a syringe equipped with an attachment to fit the tubing. After the stomach is emp-
tied, the tube should be attached to a suction apparatus constructed by suspending a jar
filled with water several feet above the person's body, as shown in the accompanying
diagram. (A lower bottle can collect the drainage.) ( Fig. 20-5 .)
7. Nasogastric tubeshaveatendency tobecome obstructed bymucusorparticles offood.
Therefore, the tube should be flushed with a small amount of a salt solution (or water
if a salt solution is not available) every two hours. (The fluid used to irrigate the tube
must be subtracted from the total volume lost through the tube when calculating the
person's fluid requirements.)
The total volume of fluid lost through the nasogastric tube must be carefully measured
and recorded. All the fluid lost in this manner should be replaced intravenously with a bal-
anced salt solution or saline.