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. 

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) 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. 

2) 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.

3) 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. 

4) 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.

5) 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. 

6) 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.  

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.