Nasogastric Intubation: Using the Stroke Feeding Tube
Suffering from a stroke is just the beginning of a series of problems that a patient will most likely face. Strokes are a medical emergency because they risk damaging the sensitive neurons in the brain. Without these neurons an adult’s brain is incapable of carrying out the essential sensory activities of the body.
A stroke is like a brain attack. When arteries supplying blood to the brain have a blockage in them, they are unable to deliver oxygenated blood to delicate neurons. Just a few seconds without oxygen can cause irreversible damage to them. In most cases, a stroke patient is left with a number of crippling post-stroke conditions that can be improved, but are permanent to some degree.
As the brain cells get injured during a stroke, the body suffers from numbness and paralysis. With no muscle coordination between the various parts of the brain and the face, a patient is unable to chew or swallow, a condition called Dysphagia. It is at this stage that the use of a stroke feeding tube becomes necessary.
The medical term given to a process with which a stroke feeding tube is installed is called nasogastric intubation. The stroke feeding tube is inserted via the nose, hence the term ‘naso’, and goes into the stomach, hence the term ‘gastric.’ Doctors usually make sure that the tube is inserted deep into the stomach to prevent the need for reinserting.
Difficulty in Learning to Swallow after Stroke
After the body goes through such a trauma, the need for nutrition becomes all the more pronounced. Even though the patient is in no state to get back to the daily routine, the body still needs to recuperate at a steady rate while the patient is at bed rest. The nutrient level in the body has to be maintained so that internal bodily functions carry on as usual.
Coupled with the inability to move, when the facial muscles are stiff and paralysed, learning to swallow after stroke can take a long time. Therefore, the only way stroke patients can receive the essential nutrients is with the stroke feeling tube. In cases of ischemic strokes, most patients suffer from paralysis on one side of the body. Such a condition makes it impossible for food and medicine to be taken orally.
Nasogastric intubation is then administered and the stroke feeding tube stays in place till the patient is strong enough to learn swallowing exercises for dysphagia through physiotherapy lessons. Using these exercises, physiotherapists guide dysphagia patients on the best posture and breathing techniques to make swallowing easier and less painful.
Risks of the Stroke Feeding Tube
A stroke feeding tube is inserted while a patient lays down flat on his back. The thin nasogastric tubes are inserted in the nostrils and directed towards the throat. Care must be taken to ensure that the stroke feeding tube does not enter the trachea. An x-ray can be carried out to see whether the tube is safely inside the stomach or not.
While nasogastric intubation is a necessity and medical experts are highly trained to carry out this process, a number of complications and risks are also associated with it.
•Nausea and vomiting.
•Cramping or swelling in the abdominal region.
•The tube getting into the lungs, causing further breathing problems.
•Obstruction or blockade inside the tube that becomes very uncomfortable for the patient.
•A tear or perforation in the nasogastric tube.
•Regurgitation of the any food or medicine that is passed along the tube.
•Accidental stretching or pulling that can cause pain in the throat and nasal passage.
•Sinusitis, which makes it difficult for the patient to breath through the nose.
•Infections are a prominent risk if the tube is left in the throat for too long.
•Ulcerations that forms on the tissues of the throat or stomach.
It is important to note that stroke feeding tube prognosis can be improved by re-evaluating in regular intervals. The improvement is twofold, firstly to ensure that the tube is working well and is not causing undue pain to the patient. Secondly, a consistent re-evaluation can help physicians determine whether the nasogastric tube can be removed or if it is needed for some more time. Ultimately this will ensure that a stroke feeding tube prognosis is in the patient’s favour.
Swallowing Exercises for Dysphagia
There are a number of swallowing exercises for dysphagia that can be used to improve this condition, after which the stroke feeding tube can be removed. The experts moderating these exercises guide patients on the number of repetitions to be done, the rest period in between each exercise, as well as the duration of time each is to be performed.
Effortful Swallowing: Effortful Swallowing forces the muscles in the mouth and the throat to contract and relax. A patient is told to collect a lot of saliva in the middle of the tongue, with the lips and mouth closed. He then swallows the saliva in one big movement just like a small grape would be swallowed.
Masako Maneuver: This exercise requires patients to stick out their tongue in between the front two teeth. They are then told to swallow while holding the tongue in this position.
Lollipop Swallowing: A small lollipop is kept inside the mouth. The patient is told to lick it three times and then do an effortful swallow.
Jaw Thrusts: Jaw thrusts are one of the easiest swallowing exercises for dyspnea. They require patients to push out the lower jaw as far out as possible with the lower teeth in front of the upper teeth.
Mendelsohn Maneuver: Mendelsohn Maneuver requires patients to keep the first three fingers on their Adam’s apple. They are then told to swallow and feel the Adam’s apple move upward. When it reaches the highest point, the throat muscles are to be contracted to hold the Adam’s apple at this position.
Supraglottic Maneuver: This exercise directs patients to collect a bit of saliva in the mouth, then take a deep breath and hold it. Next, patients have to swallow while holding their breath.