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Other: Gastrointestinal - Procedures - Nasogastric Tubes
Nasogastric Tubes [NGT NG tube][sump drains][Repogle tubes][pediatric surgery][Ventrol Levine]

Additional Medical Flashcards




Nasogastric tubes: Levin tube, Salem sump tube

Nasogastric tubes


- NG tubes are used for:

1) gastric decompression

2) gastric lavage

3) administration of oral contrast material


- Pass the largest size tolerable to the patient

1. Levin tube

  - a soft tube with a single lumen. Connect to low intermittent suction to prevent the gastric mucosa from occluding the tube




2. Salem sump tube -- Dual-lumen tube

  - the main lumen should be placed on low continous suction.

  - A side-port (blue) vents the tube to allow continous sump suction without injury to the mucosa

  - The vent should be flushed with 15mL of air and the main lumen with 30mL of saline Q3-4H to ensure patency.

  - The vent is patent when it "whistles" continously.

  - The vent should never be flushed with liquid.



SUMP DRAINS (surgery pocket guide)

- A second lumen, open to air provides a continuous air circuit

- Salem sump NGTs are used for the stomach

- The sump drain has the advantage of not sucking closed all of its aspiration ports

- occasionally intermittent vacuum is used in some sump drains in an effort to keep these drains open

- NG sump drains are opened with boluses of 30cc NS or water

- Never bolus drains which decompress a fresh anastomosis, let your resident know that the tube has stopped functioning




mont reid p.721 

surgical intern survival guide p.35

Nasogastric tubes: Videos

Nasogastric tubes: Videos












Lactated Ringers: Multiple choice question! WHAT?

Crystalloids: Multiple choice questions!


A 53 year old man with no significant medical problems undergoes lysis of adhesions for a small-bowel obstruction. Postoperatively, he is placed on lactated Ringer's solution for the first 24 hours. Which of the following is true regarding lactated Ringers?


a. It contains a higher concentration of sodium ions than does plasma

b. It is most appropriate for replacement of nasogastric tube loses

c. It is isosmotic with plasma

d. It has a pH of less than 7.0

e. It may induce a significant metabolic acidosis









The answer is d. (Townsend, p.98, Brunicardi, p.53)


Isotonic saline solutions contain 154 meq/L of both sodium and chloride ions. Each ion is in a substantially higher concentration than is found in the normal serum (Na = 142 meq/L; Cl = 103 meq/L)


When isotonic solutions are given in large quantities, they overload the kidney's ability to excrete chloride ion, which results in a dilutional acidosis.


They also may intensify preexisting acidosis by reducing the base bicarbonate--carbonic acid ratio in the body.


Isotonic saline solutions are particularly useful in hyponatremic or hypochloremic states and whenever a tendency to metabolic alkalosis is present, as occurs with significant nasogastric suction losses or vomiting.


Administration of lactated Ringer's solution is appropriate for replacing gastrointestinal losses and correcting extracellular fluid deficits.


Containing 130 meq/L sodium, lactated Ringer's is hyposmolar with respect to sodium and provides approximately 150mL of free water with each liter given.


Although thi is ordinarily not a significant load, in some clinical situations it can be.


Lactated Ringer's is sufficiently physiological to enable administration of large amounts without significantly affecting the body's acid-base balance.


It is worth noting that both isotonic saline and lactated Ringer's are acidic with respect to the plasma: 0.9% NaCl/5% dextrose has a pH of 4.5, while lactated Ringer's has a pH of 6.5




pretest surgery p.14, 32

Nasogastric tube: ?? ABG abnormality?? Multiple choice questions!

ABG: Multiple choice questions!


A previously healthy 55 year old man undergoes elective right hemicolectomy for Stage I (T2N0M0) cancer of the cecum. His postoperative ileus is somewhat prolonged, and on the fifth postoperative day his nasogastric tube is still in place. Physical examination reveals diminished skin turgor, dry mucous membranes, and orthostatic hypotension. Pertinent laboratory values are as folows:


ABG: pH 7.56, PCO2 50mmHg, PO2 85mmHg

Electrolytes: (meq/L): Na 132, K 3.1, Cl 80, HCO3- 42

Urine electrolytes (meq/L): Na 2, K 5, Cl 6


What is the patient's acid-base abnormality?


a. Uncompensated metabolic alkalosis

b. Respiratory acidosis with metabolic compensation

c. Combined metabolic and respiratory alkalois

d. Metabolic alkalosis with respiratory compensation

e. Mixed respiratory acidosis and respiratory alkalosis











The answer is d. (Greenfield, pp. 367-368)


The patient has a metabolic alkalosis secondary to gastric losses of HCl, with compensatory hypoventilation as reflected by the elevated arterial pH and PCO2 and supported by the absence of clinical lung disease.


The pCO2 would be normal if the metabolic alkalosis was uncompensated.


A respiratory acidosis with metabolic compensation would be characterized by decreased pH, increased pCO2 levels, and increased bicarbonate levels.


Mixed acid-base abnormalities should be suspected when the pH is normal but the PCO2 and bicarbonate levels are abnormal or if the compensatory responses appear to be excessive or inadequate.


The combination of respiratory acidosis and respiratory alkalosis is impossible.




pretest surgery, p.3, 21; question #8

Nasogastric tubes [coda presentation]

Nasogastric tubes [coda presentation]


- sump tube

- if it's working, you can hear a whistle, especialy if you put it by your ear

- so if the nurse calls you to say it is whistiling, it is ok. it is suposed to whistle

- how about if the blue thing is filled with bile? well, that's bad. that means that the NG tube isn't working (clogged, maybe), and the fluid is now backing up into the sump tube, which is only supposed to have air in it

- so this means you need to flush your NG tube

- now what syringe do you use to flush? there is a 60mL with a long tube at the end, and one with a short end. you use the one with the long thing sticking out. the one with the long thing sticking out is called a Tomey. (the one with the short thing sticking out is called the Louer Lock. don't use that).

- now there is this connection piece that actually connects to the NG tube end, that allows you to connect the Louer Lock to the end.

- the connecter thing can also serve as a plug for the sump tube if the patient is like beging carted away or something so that the NG tube/sump tube doesn't overflow out into the patients shirt or something


dr. maa presentation CODA

Orders for NG tube

Orders for NG tube



Lidocaine 4% nasal solution (use with MAD300 atomizer for NG tube placement)


cetylpyridinium lozenge 1 Lozenge (cepacol)

cetylpyridinium 3 mg Lozg


phenol (CHLORASEPTIC) 1.4% throat spray 1-2 Spray [110175167]

If someone has an NG tube, do not give them oral meds. Give it through IV if you can.
Pediatric surgery: Repogle tubes

Pediatric surgery: Repogle tubes


- If the patient has intestinal obstruction, place Repogle tube to continuous suction and measure output



ucsf NICU, p.162

Nasogastric tubes
Chest xray showing NG tube in the stomach
04816869  6/2/10
You can put Ventrol Levine tubes to off suction like we did in patient 05108305. It's basically just capped when you do this. The output can be seen in the tube.
People can still vomit with a nasogastric tube in. If the patient is vomiting with an NG tube in, you have to flush it b/c it's likely not draining. also write an order for the nurses to flush the NG tube Q4H with several mL of normal saline. (water should be fine, I think)
Nasogastric tubes: An order you can put in when you clamp the NG tube


Routine, ONCE, Fri 12/31/10 at 1145, For 1 occurrence
Tube type: Nasogastric/Adult
Tube care type: flush, Check residuals
Drainage mode: no suction
Q4 hour check residual, then flush with water. Use NG to administer PO meds if unable to swallow.

Nasogastric tube: Electrolyte abnormalities


In adults, one can have hypochloremic, hypokalemic, metabolic alkalosis occuring with NG tube suctioning. Treatment is maintenance D5 1/2NS + 20mEq of K.



vomiting [or NG tube suctioning] is losing both water and HCl (this is the hypochloremia part and the metabolic alkalosis part of the equation)


To compensate for the water loss, the kidney reabsorbs Na in exchange for K (this is the hypokalemia part)


Also, the kidney recognizes that it is losing K so it exchanges K for H, which results in paradoxical aciduria


Teh end result is hypochloremic, hypokalemic, metabolic alkalosis with paradoxical aciduria



the absite question book, p.24

Troubleshooting NG tube placement
- If you put the tube in and the patient gags and vomits stuff out, make sure their airway is ok. Next, have them open their mouth and make sure the tube isn't balled up on the back of their throat.
5/1/11 K___g 8836: Chest xray showing NG tube in stomach
Patient with NG tube with sump tube (external, blue)
- This tube needs a filter at the tip (a connector, white and blue ends) for the sump tube
- When you push air into the sump tube and it should subsequently whistle if it is working
- For the external sump tube, you just need a 60cc syringe with a regular blue connector (you do not need to Toomey syringe for that. )

05340676 7/11/11 admission

- If a patient vomits once and has a distended abdomen after surgery, is burping, and feels nauseus, offer them an NG tube placement. They probably have some kind of ileus and it will make them feel better and resolve that problem.

- If a patient has NG tube place and you notice that they are bleeding, put the suction to low intermittent suction so that it doesn't go against the mucosa and irritate it, causing bleeding.

- When you first place an NG tube, you want it at LOW CONSTANT SUCTION. However, if it is a small amount, non-bilious, or the output is low, then you put it on LOW INTERMITTENT SUCTION because you don't want to be sucking to hard on the mucosa.

ALWAYS flush the NG tube with water and air to test it to make sure it is working when you go into a patients room

If water goes through a sump tube then it's probably not going to work as well and you want to consider changing it



- 05340676: The patient was started on clears. Became distended, was burping, and was nauseaus. Was not yet passing gas. Decision was made that NG tube was indicated.


- When the patient's NG tube is low <200cc/shift, or is brown, then you can try clamping trial of NG. After 4 hours, if the NG output is less than 100-200cc (residual; i.e.after you put it back on suction, how much comes out?); then you can remove the NG tube and start the patient on clears.

- Once the patient is tolerating 1liter PO clears, then you can advance to general diet.

NG tube order by Dr. Skeete (also pt had thick NG output too)
Do not tape to nose
Flush every 4hr with 30cc of water to maintain patency
Clamp ng for 30 minutes after meds

phenol spray NG tube