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INTRODUCTION:
Since the beginning of the last century , different types of probes
have been applied, according to the requirements of the patients. The reasons
for this application are due to various circumstances that the EINLEITUNG: Seit
Anfang des letzten Jahrhunderts werden verschiedene Arten von Sonden
eingesetzt, je nach den Bedürfnissen der Patienten. Die Gründe für eine solche
Anwendung sind auf verschiedene Umstände zurückzuführen, die sie betreffen. Zu
den Zielen, die es zu erreichen gilt, gehören: • Einrichtung einer
Drainagemöglichkeit von der betroffenen Höhle nach außen • Zu diagnostischen
Zwecken • Ernährung im Falle der Magensonde oder Spülung im Falle des
Blasenkatheters. Es gibt verschiedene Arten von Sonden und Anwendungsrouten
von ihnen. Die am häufigsten verwendeten sind die nasogastrale oder nasojejunale
(bei Neugeborenen sollten aufgrund ihrer Atembedingungen oropharyngeale Eileiter
gelegt werden), die Sengstaken-Blakemore-Sonde, die Kerr-Sonde, Blasen- oder
Blasenkatheter und die Rektalsonden. Jeder von ihnen sollte so platziert werden,
dass der Zustand des Patienten gelindert wird, und entfernt werden, sobald die
Entwicklung des Patienten es zulässt. THEORETISCHER RAHMEN: Inside ... afflict.
Among the objectives to be achieved are:
• Establish a means of drainage from the affected area to the outside
• For diagnosticpurposes
• To feed in the case of the na-ogastric tube , or irrigate in the case of the urinary
catheter.
Thereare different types of probes and pathways of applying them. The most used
are thena-sogastric or nasojejunal, (inr e hundred born, due to their breathing
conditions, oropharyngeal should be ) Sengstaken-Blakemore tube, Kerr probe,
bladder or urinary catheters , and rectal tubes .
Each of these should beplaced in such a way that the patient's condition would be
in such a way as to be the patient, and should be removed as soon as the
patient's evolution would evolve. Allow it .
MARCO
TEÓRICO:
Within the techniques applied by health personnel , there are various types
ofprobes or intubations to be performed, according to the needs of the
patient. But it is that any knowledge we practice must be explained, with the
aimof reducing the temperature of the discomfort, pain or discomfort that may
causeit..
The use of a probe causes pain and discomfortwhen moving throughany ofthe
products tobe used,so it shouldbe made known what it can do, and explainhow
these disturbances can be minimised.
Among thedaysused in the digestive system , we have the nasogastricca o de
Levin tube, the Sengstaken-Blakemore tube, the Kerr tube and the feeding tube.
NASOGASTRIC
CATHETER (NS):
Concep
t
Nasogastric probing involves the introduction of a catheter (nasogastric tube)
through one of the nasal origins into the stomach.
It is performed by a professional with the collaboration of
the technician.
Procedure
• Explain to the patient the technique to be performed by asking for his collaboration.
• Gather the material to be used
• Make a surfficial measurement of the intended path (spath of the nose, back
of the ear and epigastrium), mark this point with cloth or with a pencil.
• Place the patient in the supine position Fowler, incorporated at 45° and the z fit
slightlyt and inclined forward.
• Wash your hands and prepare the materials that the nurse will use , apply
serum to the distal 30 cm of the probe.
• Collaborate in the procedure by asking the patient to swallow saliva and taking
advantage of these moments of swallowingthe probe will advance.
• Once thepoint specified in the initial measurement has been reached , gastric
contents may begin to leak out of the tube; if this does not happen, thesyringe
should be aspirated, if gastric contents are removed. confirm its status.
• If we still do not obtain gas content ,we must introduce 20 cm. of air withthe
syringe, at the same time that we auscultate the epigastrio, trying to heara
noiseof bubbles in the stomach indicatingthe essence ofair in the cavity, or
placing the free end of the probe in a container with water, if there
is burbujas indicac a found in lungs.
• Attach the probe with cloth to the cheek of the patient.
The tube can:
• Connect to enteral nutrition equipment . (not ideal)
• Connect to intermittent vacuum . Do not exceed the
negative pressure of 30 mm. Hg ( continuousaspiration)
• Connect toa bottle or bowl below the level ofthe stomach
to facilitate the exit of gastric content by gravity. (it
is the most used)
• Record the procedure in the Nursing Sheet , as well as
the numberand amount of content
extracted; and the difficulties if any.
Recommendations:
• You should never press more than
you should , as there may be
some type of obstruction and we
could cause some lesiorn.
• Remove as soon as possible if we
observe the patient with
some form of respiratory distress.
• In newborns , oropharyngeal
shouldpreferably be placed , due
to the breathing conditions of these
patients
SENGSTAKEN-BLAKEMORE PROBE :
The Sengstaken-Blakemore probe is the most commonly used when it comes to
controlling bleeding due to esophageal varices.
It consists of a probe with three routes, one for gastric lavage and the other two
remaining are communicated with the gastric and esophageal balloons. There are
probes with a fourth pathway, which allows the aspiration ofthe ophthalmic conid. If
this does not exist, it is recommended the colorcation of an adicional tube parallel to
the Sengstaken-Blakemore probe along the esophagus,which prevents theaspiration
of secretions and blood remains that once the balloons inflated, can not
pass into the stomach from the esophagus, thereby reducingthe risk of bronchial
aspiration .
For the placement of the Sengstaken-Blakemore probeit is recommended to follow
the following rules:
NOTE: It is a probe that is placed in places that are bleeding, and therefore the
health team must act quickly and accurately.
The probe is placed by the nurse
1. Before placement, both balls must be checked. The gastric balloonis a balloon of
volume, which means that once placed in the patient it mustbe
inflated with a certain amount of air (250 ml.). The esophageal balloon,on the contrary, is
a pressure balloon , so after its cabbageorcacion must be inflated with a certain amount
of air to maintain a pressure determinated (35-40 mm Hg).
2. Once the gastric cavity has been l aford of blood and the diagnosis of varicose
vein bleeding confirmed, the probe debe lubricada and pa sada a tra vés from the
mouth or nose hastto the stomach. The gastric situ will be confirmed in the traditional
way, injecting air through thegastriclavage l uz and auscultando on the
abdomen superior.
3. Initially the gastric balloon is inflated with aors 100 ml of air, lueg o de traccio na
slightly until the balloon fits into the area of the cardia, then inflate the remaining 15
0 ml of air.
4. If the probe lacks a fourth way, an ordinary probe is placed in
the esophagus thatallows us to aspirate secretions .
5. The Sengstaken-Blakemore tube must be fixed externally, once the gastric balloon
is embedded in the gastroresophageal junction
6. If the bleedingis continuedto be produced, it is assumed that the source of it are varicose
veins that fágic, with which weinflate the balloon esophageal. This must be carried
with air until reaching a pressure of 35-40 mm Hg.
7. The collection and handling of a probe by persons familiarizesthem with their use.
8. In case of having que be c o loeach in pacientes s or mnolientos, obnubilad or
sorcomatose , it is preferable the previous orotracheal intubation.
9. It is recommended thatthe esophageal balloon be deflated by half
an hour for every 12 hours of the oesophageal balloon, in order
to reduce the risk of oesophageal ischemia. mucosa. Itis not necessary to say
that the maintenance of Sengstaken-Bl a kemore is a temporary
measure , while planning orother forms of action.
FEEDING TUBE :
Technique
Note: The collaboration of the personandthe
party is very important in the procedure.
• Wash your hands
• Place the woman in a flat position with her knees flat and apart; The man in supine
position.
• Put on procedure gloves .
• Perform the genital ao eo , on a flat.
• Remove your gloves and wash your hands.
• Prepare a field of sterile area, clean area and dirty area.
• Prepare gloves aresterile
• Handleand present the equipo, the paños and the so, without taminar.
• Aplique suero en el extremo distal de la sonda. (actúa como lubricante)
• Prepare un recipiente para recibir la orina (riñón).
• Si se va a insertar una sonda permanente prepare una jeringa con la cantidad apropiada
de agua estéril para inflar el globo: (chequear la indemnidad del balón)
• Es seguro el acceso a la vejiga cuando fluye orina
• Si se necesita muestra estéril ponga el extremo abierto de la sonda en un recipiente estéril
y llévelo a laboratorio lo antes posible.
• Conecte el extremo de la sonda al recolector urinario, fíjelo con tela o con fijador en la
pierna.
• Fije el recolector a la cama. Comprobando que queda bajo el nivel de la vejiga.
• Registre el procedimiento, la calidad y cantidad de orina extraída
• Para extraer una sonda permanente píncela para no derramar orina durante la extracción.
Desinfle el globo extrayendo el agua estéril mediante una jeringa. Saque con suavidad
la sonda de la uretra, deséchelo tan pronto como sea posible.
• Limpie el meato si es necesario.
NOTA: El alumno investigará para el taller y traerá un análisis escrito de
3 complicaciones y 3 cuidados de las sondas vesicales
SONDEO RECTAL:
Concepto
El sondeo rectal consiste en la introducción de una sonda en el recto a través del
ano.
Se coloca cuando un paciente presenta una acumulación de gases en el intestino
(meteorismo abdominal o flatulencia), situación por otra parte corriente en los
postoperatorios. Dicho todo esto, sólo nos queda añadir que la finalidad de la
sonda es facilitar la evacuación de dichos gases.
Técnica
• Colocar al paciente en posición de Sims izquierda. (lateralizado)
• Lubricar la sonda en su extremo distal.
• Introducir suavemente la sonda rectal de 15 a 20 cm.
• Colocar el extremo proximal de la sonda en una cuña con gasas, ya que la
emisión de gases a veces se acompaña de expulsión de materias fecales
líquidas.
• Dejar la sonda puesta durante 20 minutos.
INSUMOS Y EQUIPOS
SNG
•
1 Sonda nasogástrica de una o de
doble vía (sonda de alimentación
para que los alumnos la conozcan)
• 1 ampolla de suero para lubricar.
• Jeringa de cono ancho.
• Bolsa recolectora, pinza Kelly o
bomba de alimentación
• Fonendoscopio.
• Guantes de procedimiento.
• Riñón.
• Tela adhesiva
• Toalla de papel
• Lápiz o hilo
• Frasco
SONDA VESICAL
• Bandeja de cateterismo vesical
• Guantes estériles y de procedimiento
• Recipiente de muestra
• 1 ampolla de suero
• Agua, tórulas de algodón
• Jarro plástico
• Chata
• Sonda Folley apropiada.
• Sistema recolector.
SONDA RECTAL
• Sonda rectal estéril (Nelaton).
• Lubricante hidrosoluble.
• Gasas.
• Guantes de procedimieto
...