• Journal of Nutrition and Health
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• v.26 no.6
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• pp.793-803
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• 1993

This study was designed to measure viscosity, osmolality and in vitro flow rates via nasogastric tubes for 6 types of commercially available and 9 hospital-blenderized enteral solutions and to examine the effect of viscosity and osmolaility of enteral formula on the flow rates in gravity drip administration. Each solution was infused through 18, 16, 14, 12 French sizes of silicone rubber tube. Flow rates were measured six times at $25^{\circ}C$ using formula bags and drip sets hung at a uniform height on a intravenous drip stand with tube uniformly positioned in collecting container. Viscosity ranged widely from 16.0 to 195.5 cps with mean, 64.61$\pm$64.42 for hospital-blenderized formula while mean viscosity of commercial formula was 7.60$\pm$4.84 cps. Mean osmolality of commercial formula and hospital-blenderized formula were 370$\pm$100.80, 540.33$\pm$89.37 mOsm/kg respectively. There was negative relationship between viscosity of formula and flow rates through tubes but no significant relationship between flow rates and osmolalty. Some of hospital-blenderized formula was too viscous to be infused througth tube with gravity drip administration and the recipe of formula requires to be modiifed. On the other hand, commercial formula with the low viscosity flows too rapidly with large bore size tubes. Smaller size of tube must be selected for hyperosmolar solution to decrease possible side effects associated with tube feeding. Two kinds of regression equations for flow rates obtained according to viscosity and tube sizes were also presented for the purpose of practical uses. In conclusion, this study emphasizes that viscosity of fomula, osmolality, patient's tolerance and comfort, caloric density should be considered in the selection of tubes for gravify drip administration.

• Journal of Korean Academy of Nursing
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• v.44 no.4
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• pp.437-445
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• 2014

Purpose: This study was done to identify pain perception (P-PER) by nurses and pain expression (P-EXP) by patients in critical care units (ICUs) and degree of agreement between nurses' P-PER and patients' P-EXP. Methods: Nurses' P-PER was measured with a self-administered questionnaire completed by 99 nurses working in ICUs during May, 2013. Patients' P-EXP was measured with the Critical Care Non-Verbal Pain Scale through observations of 31 ICU patients during nine nursing procedures (NPs) performed between May and July, 2013. Results: Nurses' P-PER was from 4.49 points for nasogastric tube (NGT) insertion to 0.83 for blood pressure (BP) measurement based on a 9-point scale, Patients' P-EXP was 4.48 points for NGT to 0.18 for BP measurement based on a 10-point scale. Eight NPs except oral care showed higher scores for nurses' P-PER than for patients' P-EXP. Position change (p=.019), subcutaneous injection (p<.001), blood sugar test (p<.001), and BP measurement (p<.001) showed significant differences between nurses' P-PER and patients' P-EXP. Conclusion: Nasogastric tube (NGT) insertion was scored highest by both nurses and patients. Eight NPs except 'oral care' showed nurses' P-PER was higher or similar to patients' P-EXP, which indicates that nurses may overestimate procedural pain experienced by patients.

• Journal of Korean Critical Care Nursing
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• v.7 no.1
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• pp.1-10
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• 2014

Purpose: The purpose of this study was developing a nasogastric tube feeding algorithm to prevent aspiration pneumonia. Methods: The algorithm was developed through a methodological design. First, a pilot study was performed to determine the incidence of pneumonia. The second step was development of a preliminary algorithm through a literature review and collection of nurse opinions. The third step was to establish content validity using a panel of 12 experts. The fourth step was revision of the algorithm. Next, 20 intensive care unit nurses applied the revised algorithm for six months to their actual treatment, and the practical feasibility was verified after that. Results: In the patients for whom this algorithm was applied, no cases of pneumonia occurred. The algorithm that was developed by the present author was suitable for clinical application. Conclusion: The effect and practical feasibility of the algorithm was tested with a few patients in this study. The effect of this algorithm should be examined by applying it to more patients on an ongoing basis.

• Research in Community and Public Health Nursing
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• v.28 no.3
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• pp.324-333
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• 2017

Purpose: The purpose of this study was to develop a simulation module for teaching home health care and evaluate the applicability of the program to nursing students' practical training. Methods: The simulation module was developed based on the National League for Nursing Jeffries Simulation Theory. The theme of the developed scenario was teaching nasogastric tube feeding to the caregiver of patient with Parkinson disease. Participants were 61 nursing students who had learned tube feeding, and participated in the questionnaire survey after the simulation training. Results: The evaluation of simulation design showed the highest score on feedback/guided reflection, and was highly evaluated in the order of objectives/information, problem solving and fidelity. The educational practice of the simulation was highly evaluated in the order of active learning, high expectation and diversity of learning. The nursing students showed high satisfaction and self-confidence after the simulation education. Conclusion: We suggest that the developed simulation module can be applied to practical training for home health care. In the future, the change of self-efficacy, clinical judgment and performance ability of the students after the simulation education should be identified. Also, various simulation modules related to the community health nursing competencies should be continuously developed and verified.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.35-39
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• 2006

A 77-year-old female presented panperitonitis due to advanced gastric ranter during palliative care. In the case of panperitonitis following obstruction or perforation, surgical treatment is vital to avoid fatal sepsis and dehydration. However, the risk of surgery and the residual life of a patient must be carefully considered because of high mortality and complication rate in those patients with advanced disease due to the poor condition. The therapeutic value of aggressive hydration, nasogastric tube insertion, and the use of antibiotics is also questionable. Palliative surgery was not performed on this case, and she passed away peacefully in the presence of family after 4 days of palliative medical care. Here is the appropriate management for this kind of patients we would like to recommend through review of relevant references and long discussions. Firstly, we need to predict survival time using clinical variables. Secondly, considering patient status and risk of surgery, non surgical palliative care such as pain control, transient nasogastric tube insertion, and parenteral hydration is recommended. Minimal use of fluid is desirable to minimize complications such as edema and dyspnea if massive hydration in the beginning of treatment is not proved to be effective. Even though started earlier in the course of disease, discontinuation of antibiotics could be discussed with patients and their caregiver if patient status is not improved.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.6-7
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• 1981

With the improvement of living standard and educational level of the people, there is an increasing awareness about the dangers of toxic substances and lethal drugs. In addition to the above, the governmental control of these substances has led to a progressive decrease in the accidents with corrosive substances. However there are still sporadic incidences of suicidal attempts with the substances due to the unbalance between the cultural development in society and individual emotion. The problem is explained by the fact that there is a variety of corrosive agents easily available to the people due to the considerable industrial development and industrialization. Salzen(1920), Bokey(1924) were pioneers on the subject of the corrosive esophagitis and esophageal stenosis by dilatation method. Since then there had been a continuing improvement on the subject with researches on various acid(Pitkin, 1935, Carmody, 1936) and alkali (Tree, 1942, Tucker, 1951) corrosive agents, and the use of steroid (Spain, 1950) and antibiotics. Recently, early esophagoscopic examination is emphasized on the purpose of determining the way of the treatment in corrosive esophagitis patients. In order to find the effective treatment of such patients in future, the authors selected 96 corrosive esophagitis patients who were admitted and treated at the ENT department of Severance hospital from 1971 to March, 1981 to attempt a clinical study. 1. Sex incidence……male: female=1 : 1.7, Age incidence……21-30 years age group; 38 cases (39.6%). 2. Suicidal attempt……80 cases(83.3%), Accidental ingestion……16 cases (16.7%). Among those who ingested the substance accidentally, children below ten years were most numerous with nine patients. 3. Incidence acetic acid……41 cases(41.8%), lye…20 cases (20.4%), HCI……17 cases (17.3%). There was a trend of rapid rise in the incidence of acidic corrosive agents especially acetic acid. 4. Lavage……57 cases (81.1%). 5. Nasogastric tube insertion……80 cases (83.3%), No insertion……16 cases(16.7%), late admittance……10 cases, failure…4 cases, other……2 cases. 6. Tracheostomy……17 cases(17.7%), respiratory problems(75.0%), mental problems (25.0%). 7. Early endoscopy……11 cases(11.5%), within 48 hours……6 cases (54.4%). Endoscopic results; moderate mucosal ulceration…8 cases (72.7%), mild mucosal erythema……2 cases (18.2%), severe mucosal ulceration……1 cases (9.1%) and among those who took early endoscopic examination; 6 patients were confirmed mild lesion and so they were discharged after endoscopy. Average period of admittance in the cases of nasogastric tube insertion was 4 weeks. 8. Nasogastric tube indwelling period……average 11.6 days, recently our treatment trend in the corrosive esophagitis patients with nasogastric tube indwelling is determined according to the finding of early endoscopy. 9. The No. of patients who didn't given and delayed administration of steroid……7 cases(48.9%): causes; kind of drug(acid, unknown)……12 cases, late admittance……11 cases, mild case…9 cases, contraindication……7 cases, other …8 cases. 10. Management of stricture; bougienage……7 cases, feeding gastrostomy……6 cases, other surgical management……4 cases. 11. Complication……27 cases(28.1%); cardio-pulmonary……10 cases, visceral rupture……8 cases, massive bleeding……6 cases, renal failure……4 cases, other…2 cases, expire and moribund discharge…8 cases. 12. No. of follow-up case……23 cases; esophageal stricture……13 cases and site of stricture; hypopharynx……1 case, mid third of esophagus…5 cases, upper third of esophagus…3 cases, lower third of esophagus……3 cases pylorus……1 case, diffuse esophageal stenosis……1 case.

• Journal of Gastric Cancer
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• v.2 no.2
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• pp.96-100
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• 2002

Purpose: The proper reconstructive technique after a partial gastrectomy for an adenocarcinoma of the stomach is often debated, but few data exist to clarify the issue. The aim of this study was to compare retrospectively the early postoperative results and complications after different anastomoses used during a partial gastrectomy for a gastric adenocarcinoma. Materials and Methods: We reviewed the hospital records of 218 patients who had undergone a subtotal gastrectomy for gastric cancer at Chosun University Hospital between January 1997 and July 2000. Of the 218 subtotal gastrectomies performed with curative intent, 127 reconstructions were Billroth I gastrectomies and 91 were Billroth II gastrectomies. The following data were analyzed: age, sex, tumor size, gastric resection margin, timing of removal of the nasogastric tube, first bowel movement, resumption of oral feeding, and postoperative complications. Results: The timing of removal of the nasogastric tube was significantly earlier in the Billroth Igroup than in the Billroth II group ($27.9\pm13.9$ hours and $69.7\pm68$ hours, respectively)(P<0.05). Resumption of oral feeding was possible on day $4.6\pm1.5$ in the Billroth I group and on dsy $5.2\pm1.5$ in the Billroth II group (P<0.05). There were no anastomotic leakage, postoperative bleeding, and postoperative mortality among the patients in either group. Conclusions: the Billroth lgastrectomy should be considered for patients undergoing a partial gastric resection for gastric cancer due to its physiological benefits and acceptable rate of complication.

• Korean Journal of Adult Nursing
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• v.20 no.1
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• pp.44-54
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• 2008

Purpose: The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding. Methods: Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators. Results: MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding. Conclusions: Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.205-210
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• 2020

Esophageal anastomotic leak is the most common and serious complication following esophagectomy. However, the standard treatment for anastomotic leaks remains unclear. Recently, endoscopic vacuum therapy has become an important non-surgical alternative treatment method for patients with esophageal anastomotic leak. This treatment involves the endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. Subsequently, continuous negative pressure is delivered to the cavity through the tube. Several studies have reported a treatment success rate of 80% to 100%. In this study, we review the mechanism of action, the method of performing the procedure, its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapy in the management of patients with anastomotic leak, and on this basis attempted to confirm the possibility of establishing a standardized treatment protocol using endoscopic vacuum therapy.