Understanding Levin Tubes and Their Applications in Medical Training
Levin tubes are thin, flexible nasogastric tubes inserted through the nose and into the stomach to remove intestinal secretions, deliver nutrients into the small intestine or stomach, and decompress the intestine to relieve adhesions and reduce pressure. Levin tubes may seem like simple plastic tube objects, but they are vital in treating and relieving patients of various gastrointestinal conditions.
Here are the two most common types of nasogastric tubes used in clinical settings:
1) Single Lumen Nasogastric Tube
The single-lumen nasogastric tube features one narrow channel that goes into the stomach to deliver nutrients or remove toxic contents from it. Since there is only one channel present, it can only perform one function at a time. Most doctors and nurses use a single lumen to remove stomach contents, but it can also be used for delivering nutrients or medication on a short-term basis. The single lumen is a simple design that is easy for medical students to learn and understand.
2) Double Lumen Nasogastric Tube
The double-lumen nasogastric tube is much more versatile than single-lumen nasogastric tube because it has two separate channels instead of one. There is a wider channel used for removing contents from the stomach and a narrower channel used to allow air to enter the stomach to reduce vacuum pressure. The narrow channel increases the safety of the procedure because it helps stop the tube from sticking to the gastric wall or stomach lining during the decompression process.
Medical students practice inserting Levin tubes into simulation mannequins or dummies to eliminate the risk to human patients and volunteers. Simulated medical applications allow medical students to safely make mistakes and overcome challenges when training on how to insert Levin tubes correctly.
The Purpose of Levin Tubes in Clinical Settings
Levin tubes can deliver or extract substances in the small intestine and stomach. Medical students must understand the importance of Levin tubes and their uses in clinical settings because they will often use them when treating patients suffering from gastrointestinal issues.
Let’s review the two primary clinical scenarios where Levin tubes help treat patients and save their lives.
1) Gastrointestinal Feeding
Some patients may be malnourished because they cannot consume food due to an existing medical condition. Some conditions like inflammatory bowel disease, dysphagia, endotracheal intubation, and head and neck cancers can drastically reduce a patient’s appetite and limit their swallowing or chewing abilities.
In these situations, a Levin tube will be inserted into the patient’s stomach to deliver nutrients and medication directly. That way, the patient does not need to worry about orally consuming food for nutrients and medicine because gastrointestinal feeding will ensure they stay nourished. Not only does this help patients remain alive, but it can also help them recover and heal from other health conditions and injuries.
2) Gastrointestinal Suction
Sometimes, it is necessary to remove substances from a patient’s stomach if they have ingested toxic substances or too many pills. A gastric suctioning procedure is performed with a Levin tube to extract the toxic contents from the patient’s stomach to prevent more severe injuries or conditions.
Another reason for gastric suctioning is to decompress a patient’s stomach after a gastrointestinal surgery or procedure. Gastrointestinal decompression can remove excessive amounts of fluid and air from any part of the gastrointestinal tract to relieve and comfort the patient. Removing this excess content increases blood flow in the gastrointestinal wall, allowing it to heal more quickly.
How Students Insert the Levin Tube During Medical Training
The primary objective is for the medical students to show that they understand each step of the procedure. When medical students prepare to insert a Levin tube into a patient’s stomach for the first time, they will have a trained physician guiding them. The test subject will likely be a lifelike mannequin rather than a human volunteer to prevent injuries.
Here is a rundown of how Levin tubes are applied in medical training:
1) Gather the Necessary Equipment and Accessories
The first step is to gather all the equipment and accessories needed to perform the Levin tube insertion. These include the single-lumen or double-lumen nasogastric tube, medical gloves, water-soluble lubricant, anesthetic substance, 50 mL syringe, and adhesive tape. If the student is training with a simulation mannequin, they should also have it readily available.
Some simulation mannequins come with advanced features that can accurately respond to nasogastric tube insertions. For instance, you can find mannequins that can bleed if the student inserts the tube the wrong way into the nose or stomach.
2) Talk to the Patient About the Procedure
The next step is a preliminary discussion with the patient. Medical students need to practice explaining the details of the procedure to patients so that they understand what is about to happen to them. They can also practice answering patient questions and address any concerns they might have before the Levin tube is inserted. Once the patient consents to the procedure, the student can proceed.
3) Apply Anesthetic
The first step is to numb the patient’s nasal area with an anesthetic substance. Medical students can use lidocaine or an anesthetic spray to numb the area effectively. Applying anesthetic ensures the patient has no pain or discomfort as the Levin tube is inserted through one of their nostrils and into their stomach.
4) Applying a Sterile Lubricating Gel to the Tube
Medical students must ensure the Levin tube can easily slide through the patient’s nostril. Applying a sterile lubricating gel to the first few inches of the Levin tube before inserting it is the best way to do this. It will help reduce any additional pain or discomfort the patient would have felt without the lubricant.
5) Tilt the Patient’s Head
Medical students have the patient tilt their head back until their nostrils are aligned with the back of their throat. This alignment allows the medical students to insert the tube straight down the throat without scraping or rubbing up against the throat tissues too much.
6) Insert the Levin Tube
Medical students insert the Levin tube into one of their patient’s nostrils. They gently guide the tube down the back of the throat while trying not to put much pressure on the nasal cavity. The tube must continue to pass through the esophagus before reaching the stomach.
7) Patient Takes Small Sips of Water
Medical students will have the patient take a few small sips of water with a straw to assist the tube in passing through the esophagus and entering the stomach. It may also be necessary to ask the patient to take a deep breath without exhaling for a few seconds.
If the patient gasps or shows any sign of distress, the students must remove the tube immediately. A high-fidelity mannequin may have the technology to simulate such distress for medical students if a human volunteer is not used.
8) Check The Placement
The medical students should know the proper length of the tube to insert based on preliminary tube measurements. They must verify the tube’s position once they believe it has been inserted enough to reach its destination in the stomach. The students can perform a chest X-ray or aspirate pH test to verify the correct placement of the tube in the patient.
The aspirate pH test is safer and more commonly used to avoid exposing patients to too much radiation. This test extracts a small amount of fluid from the stomach to measure its level of acidic contact. A low pH reading signifies a high amount of acidic content, which means the tube was inserted into the stomach correctly. A high pH reading signifies less acidic content, which means the tube has not reached the stomach acids yet.
Preparing Medical Students for Potential Side Effects
Medical students need to learn how to respond to the potential side effects or complications that can occur from inserting a nasogastric tube into a patient. These side effects don’t happen to all patients, but they can happen to some, especially if the tube was installed incorrectly.
Students learning to insert the tube for the first time are more likely to make mistakes, which means their patients are more likely to experience these adverse effects. Of course, they will only be practicing on simulation mannequins so that no real people will be affected. However, if an instructor sees a student doing something wrong during the tube insertion process, they can point out what the patient might experience from the mistake.
Here are some of the common side effects of nasogastric tube insertion mistakes:
1) Respiratory Distress
New students often dislodge or misplace the tube when inserting it through a patient’s nose. This mistake can have severe respiratory health consequences, such as difficulty breathing, chest pain, or possibly even a collapsed lung.
2) Nosebleed
A nosebleed can happen for many reasons. However, when it comes to nasogastric tube insertions, a patient can experience a nosebleed if the tube obstructs the small blood vessels within the inner surface of the nose. The best way a student can prevent this is to ensure they lubricate the tube well.
3) Sore Throat
Patients can develop sore throats by having the tube rub against the inner throat wall and esophageal lining. If the tube remains misaligned or unlubricated in the throat, this can even lead to inflammation and pain. That is one more reason why students need to lubricate the tube.
4) Electrolyte Imbalance
Extracting toxic elements from the stomach is important to improve a patient’s health. However, there are some potential dangers associated with gastrointestinal suction, and one of those dangers is an electrolyte imbalance. Such an imbalance occurs when the tube extracts essential electrolytes from the body, such as potassium and sodium. Once that happens, it can have severe ramifications on the patient’s muscle function and heart health.
5) Sinus Infection
The nasal passages regularly discharge mucus to clear its airways and make breathing easier. Unfortunately, nasogastric tubes can obstruct the nasal passages and adversely affect their normal drainage function. If this continues for too long, it can increase the patient’s chances of developing a sinus infection. The unwanted symptoms of such an infection include a runny nose, headache, stuffy nose, sore throat, cough, and facial pain.
6) Gastrointestinal Bleeding
Patients have been known to experience gastrointestinal bleeding when the tube has been in their stomach for too long. The tube can potentially damage the small gastric vessels or cause a gastric ulcer that results in bleeding. Medical students need to learn to monitor the patient for these conditions and to remove the tube if there are any signs of bleeding or extreme discomfort.
Please note that a nasogastric tube is only designed to stay inside the stomach for no more than six weeks. That should be enough time to supply the stomach with essential nutrients while the patient recovers from whatever condition they face. If a patient needs to continue receiving nutrients due to a long-term health issue, then a gastrojejunostomy tube will need to be inserted directly into the small intestine or stomach through a tiny outer incision.
Conclusion
Inserting Levin tubes always comes with some level of risk to the patient. The potential medical complications associated with Levin tube insertions include:
- Improper placement of the tube into the lungs
- Injuring the inner tissues of the throat, stomach, sinuses, or esophagus
- Causing extreme discomfort and potentially inducing vomiting
- Gastric aspiration resulting in breathing difficulties, chest pains, coughing, and choking
One small mistake could have severe repercussions on the health and safety of the patient. That is why medical students must repeatedly practice on mannequins and dummies until they can demonstrate a safe and professional tube insertion procedure from start to finish.