Managing Gastrointestinal Suction

Managing Gastrointestinal Suction - Note This procedure assumes an NG or other enteric tube is already in place and that its correct placement has already been verified.

Equipment
Initial Equipment Setup:
■ Nonsterile procedure gloves.
■ Suction source (either a portable machine or piped-in wall source).
■ Suction container and tubing; stopcock.

When Emptying the Suction Container:
■ Clean nonsterile procedure gloves.
■ Graduated container (not needed if suction canister is marked for measuring).
■ Antiseptic wipes.

When Irrigating the NG Tubing:
■ Nonsterile procedure gloves.
■ Irrigation set (basin and bulb syringe or catheter-tip syringe).
■ Normal saline irrigant (unless another irrigant is prescribed).
■ Linen-saver pads.

When Providing Comfort Measures:
■ Nonsterile procedure gloves.
■ Emesis basin, cup, and water for mouth care.
■ Water-soluble lubricant.
■ Cotton-tipped applicators.
■ Tissues or damp washcloth.

Assessment
■ Determine that an NG tube has been inserted and placement verified by x-ray.
■ Verify the prescriber’s order for type of tube and whether it is to be placed to suction or a drainage bag; also verify the type of suction to be used (low, high, continuous, intermittent).
■ Auscultate for bowel sounds.
■ Also assess the patient’s ability to cooperate with the procedure and understand explanations. This procedure assumes an NG tube is already in place, so assessments are ongoing.

Post-Procedure Reassessment and Maintenance
■ Periodically assess placement of the tube by a combination of methods (i.e., by checking pH of aspirate, by listening over the stomach with a stethoscope while injecting air into the tube, and by reviewing radiographic reports).
■ Monitor patency of the tube, effectiveness of the suction, and tube connections.
■ Follow agency policy or the primary care provider’s prescription for irrigation of the gastric tube.
■ It is common to irrigate with 30 to 60 mL of normal saline every 4 to 6 hours.
■ Monitor the color of the drainage (should be green to gold).
■ Be Safe! If there is blood in the drainage, notify the primary care provider.
■ Be Smart! If the NG tube does not drain:
■ Check for kinks or blockage.
■ Check the suction apparatus; if the container is higher than the patient’s abdomen, lower it.
■ If still not draining, irrigate the tube, if there is no contraindication.
■ If the tube is still not draining and the patient is uncomfortable, notify the primary care provider.
■ Assess the patient’s ability to move about in bed while attached to the suction source.
■ Monitor patient comfort (e.g., sore throat); monitor gastric distention, vomiting, and abdominal pain. Auscultate for bowel sounds.
■ Be Smart! Turn off suction while auscultating.
■ Examine skin and mucous membranes around the insertion site (e.g., nares, abdomen).
■ For clients undergoing prolonged GI suction, observe for hyponatremia and hypokalemia (i.e., fatigue, lethargy, confusion, seizures, muscle weakness, paresthesia, and cardiac dysrhythmias).
■ Be Safe! Review lab results and report symptoms to the primary care provider.

Key Points:
Initial Equipment Setup:
■ Connect and secure the suction source, collection container, and drainage tubing.
■ Don nonsterile gloves.
■ Connect suction drainage tubing to NG tubing.
■ Secure the NG tube to the patient’s nose and gown.
■ If available, connect a stopcock to the open end nearest the patient.
■ Turn on the suction source to the prescribed amount.
■ Be Safe! If there is no order, use low suction.
■ Observe that drainage appears in the collection container.

Emptying the Suction Container:
■ Don nonsterile gloves.
■ Turn off the suction; close the stopcock (or clamp the tubing).
■ Empty the suction container and measure the contents.
■ Empty and wash the graduated measuring container, if used.
■ Cleanse the suction container port and close the stopper; place the container back in the holder.
■ Turn on the suction source.
■ Observe for proper functioning and tubing patency.

Irrigating the NG Tubing:
■ Prepare the irrigation set.
■ Place a linen-saver pad on the bed under the NG tube.
■ Don nonsterile gloves.
■ Check for NG tube placement by a combination of methods.
■ Fill the syringe with 30 to 50 mL of saline.
■ Turn off the stopcock or clamp the NG tube.
■ Disconnect the NG tube from drainage.
■ Drain the suction tubing and turn off the suction source.
■ Turn on the stopcock or unclamp the NG tube.
■ Slowly instill and withdraw irrigant into the NG tube until fluid flows freely. Take care to not instill into the air vent.
■ Be Safe! Do not force the solution into the tube.
■ Turn off the stopcock or reclamp the NG tube.
■ Reconnect the NG tube to the suction tube.
■ Turn on the stopcock or release the clamp.
■ Provide comfort measures.

Providing Comfort Measures:
■ Don nonsterile gloves.
■ Provide mouth care.
■ Remove nasal secretions with a tissue, damp cloth, or cotton-tipped applicator.
■ Apply water-soluble lubricant to the inside of each nostril.
■ Check that the tape or tube fixation device is secure.

Documentation
■ Record all drainage as output on the I&O record.
■ Record the time, type, and volume of irrigations and drainage returned. Note color, odor, and consistency of drainage.
■ Document:
■ Patient’s emotional and physical responses to intubation.
■ Any evidence of tube or equipment malfunction, epigastric pain, distention, or vomiting.