What are the steps to manage a patient who is intubated and has vomited with an orogastric (OG) tube in place?

From the Guidelines

If a patient who is intubated vomits and has an orogastric (OG) tube in place, you should immediately suction the airway to prevent aspiration, then check if the OG tube is functioning properly, as recommended by the most recent guidelines 1. To manage the situation, follow these steps:

• Stop any tube feeding if it's running
• Aspirate the OG tube using a large syringe to remove gastric contents and relieve pressure in the stomach
• Flush the OG tube with 30-50 mL of water to ensure patency
• If the tube appears clogged, you may need to reposition or replace it The vomiting suggests gastric distention or delayed emptying, so consider increasing the frequency of OG tube suctioning to every 2-4 hours and possibly starting a prokinetic agent like metoclopramide 10 mg IV every 6 hours if not contraindicated, as this approach helps prevent further vomiting episodes by keeping the stomach decompressed, which reduces the risk of aspiration pneumonia in this vulnerable intubated patient 1. Key considerations include:
• The risk of gastric inflation and aspiration can be decreased by avoiding excessive peak inspiratory pressures and applying cricoid pressure in an unresponsive victim 1
• Passing a nasogastric or orogastric tube to relieve gastric inflation, especially if oxygenation and ventilation are compromised, is a recommended approach 1
• The most recent guidelines suggest that gastric decompression with an NGT before intubation may be beneficial in patients at high risk of regurgitation of gastric contents, although the evidence is not yet conclusive 1.

From the Research

Patient Intubated and Threw Up with an OG Tube

• The patient's situation involves being intubated and having an OG (orogastric) tube in place, which is used for feeding or decompression of the stomach.
• When a patient throws up with an OG tube, it is essential to assess the situation and take appropriate actions to prevent further complications.

Actions to Take

• Check the OG tube for any blockages or kinking, as this could be a cause of the patient throwing up 2.
• Ensure the OG tube is properly secured and positioned to prevent dislodgment or misplacement.
• Consider checking the patient's stomach for any residual contents or air, which could be contributing to the vomiting.
• If the patient continues to throw up, it may be necessary to administer antiemetic medication, such as ondansetron or metoclopramide, to help manage nausea and vomiting 3, 4, 5, 6.

Management of the OG Tube

• The OG tube should be checked regularly for patency and proper positioning to ensure it is functioning correctly.
• If the patient is unable to tolerate the OG tube, alternative methods of feeding or decompression may need to be considered.
• The OG tube should be removed when it is no longer necessary, as prolonged use can lead to complications such as nasal or gastric mucosal irritation.

Antiemetic Medication

• Ondansetron and metoclopramide are commonly used antiemetic medications that can be effective in managing nausea and vomiting in patients 3, 4, 5, 6.
• The choice of antiemetic medication will depend on the patient's specific needs and medical history.
• It is essential to monitor the patient's response to antiemetic medication and adjust the treatment plan as needed.