What is the management for a patient with serosanguinous output from a Nasogastric (NG) tube?

From the Guidelines

Management of serosanguinous output from a nasogastric (NG) tube should prioritize assessment for hemodynamic instability and potential bleeding sources, with consideration for removal of the NG tube as early as possible to minimize complications, as recommended by the ERAS society guidelines 1. The presence of serosanguinous output from an NG tube indicates the need for careful evaluation and management to prevent further complications. Key steps include:

• Monitoring vital signs and assessing for hemodynamic instability, as significant bleeding can lead to shock
• Obtaining laboratory tests including complete blood count, coagulation studies, and type and cross-match
• Increasing the frequency of NG tube output monitoring to every 1-2 hours to track volume and character of drainage
• Considering administration of intravenous proton pump inhibitors such as pantoprazole 40mg IV twice daily or esomeprazole 40mg IV daily to reduce gastric acid production and promote healing of potential mucosal lesions
• Fluid resuscitation with isotonic crystalloids should be initiated if there are signs of hypovolemia
• Correcting any coagulopathy with appropriate blood products if needed
• Consulting gastroenterology for possible urgent endoscopy to identify and potentially treat the bleeding source The ERAS society guidelines recommend that nasogastric tube use should be considered on an individual basis, taking into account the risk of gastric stasis and aspiration related to gut dysfunction, and that daily revaluation of the need for NG tube should occur, with removal as early as possible 1. Additionally, a multifaceted approach to minimizing postoperative ileus, including omission or early removal of nasogastric intubation, should be used 1. It is also important to note that mechanical complications, such as dislodgement and obstruction of the tubes, are more frequent in nasal tubes than in PEG tubes, and that routine water flushing after feedings can prevent tube occlusion 1. Overall, the management of serosanguinous output from an NG tube requires a comprehensive approach that prioritizes patient safety and minimizes potential complications.

From the Research

Management of Serosanguinous Output from NG Tube

• The management of serosanguinous output from a Nasogastric (NG) tube is crucial to prevent complications and ensure patient safety.
• According to 2, octreotide can be effective in controlling acute bleeding in patients with portal hypertensive gastropathy, which may be a cause of serosanguinous output from an NG tube.
• The study 2 found that octreotide required less time and fewer blood transfusions to control bleeding compared to vasopressin and omeprazole.
• However, the use of octreotide for serosanguinous output from an NG tube is not directly addressed in the provided studies.

Determining NG Tube Placement

• To manage serosanguinous output from an NG tube, it is essential to ensure correct tube placement.
• The study 3 found that capnography or colorimetric capnometry can be used to identify feeding tube placement in mechanically ventilated patients.
• However, the study 3 also noted that the limited evidence does not provide a substantial base for the development of practice guidelines.

Enteral Tube Feeding

• Enteral tube feeding can be an important tool in the treatment of malnourished patients, including those with chronic hemodialysis 4.
• The study 4 found that enteral tube feeding can improve serum albumin levels, but hypophosphatemia can occur, and phosphorus levels should be closely monitored.
• However, the study 4 does not directly address the management of serosanguinous output from an NG tube.

Monitoring and Assessment

• Monitoring and assessment of the patient's condition, including vital signs and laboratory results, are crucial in managing serosanguinous output from an NG tube.
• The study 5 used ultrasound to position the NG tube and monitor the patient's condition, which may be a useful approach in managing serosanguinous output.
• However, more research is needed to determine the best approach to managing serosanguinous output from an NG tube.