From the Guidelines
A nasogastric (NG) tube should be removed as early as possible, with daily revaluation of the need for NG tube use, taking into account the risk of gastric stasis and aspiration related to gut dysfunction. The decision to remove the NG tube should be individualized based on the patient's clinical improvement, resolution of symptoms, and radiographic evidence 1. According to the consensus guidelines for perioperative care, nasogastric tube use should be considered on an individual basis, and it should be removed as early as possible to minimize postoperative ileus and reduce the risk of complications 1.
Some key considerations for NG tube removal include:
- Daily revaluation of the need for NG tube use
- Assessment of the risk of gastric stasis and aspiration related to gut dysfunction
- Evaluation of the patient's clinical improvement and resolution of symptoms
- Radiographic evidence of improved gastrointestinal function
- Minimizing postoperative ileus through a multifaceted approach, including early mobilization, early postoperative food intake, and omission/early removal of nasogastric intubation 1
It is essential to note that the ESPEN guideline on clinical nutrition and hydration in geriatrics recommends that the indication and expected benefits of enteral nutrition (EN) should be reassessed on a regular basis, and EN should be discontinued if the patient's ability for oral feeding improved substantially, or if an advantage of EN is no longer expected 1. However, the most recent and highest quality study, which is the consensus guidelines for perioperative care, provides more specific guidance on NG tube removal 1.
In real-life clinical practice, the removal of the NG tube should be prioritized to minimize complications, reduce patient discomfort, and improve quality of life. Therefore, the NG tube should be removed as soon as it is no longer necessary, with careful consideration of the patient's individual needs and clinical status.
From the Research
Removal of Nasogastric Tube
The decision to remove a nasogastric (NG) tube should be based on the individual patient's needs and medical condition. Several studies have investigated the routine use of NG tubes after abdominal surgery and their findings can inform this decision.
Findings from Studies
- A study published in 2007 2 found that routine nasogastric decompression does not accomplish its intended goals, such as hastening the return of bowel function, preventing pulmonary complications, or shortening hospital stay.
- Another study from 2010 3 concluded that nasogastric decompression can be safely omitted from routine postoperative care after elective enteric anastomosis.
- A prospective randomized trial from 1992 4 found that patients without routine NG decompression had earlier bowel sounds, return of flatus, oral intake, and first bowel movement, with no significant differences in postoperative complications.
- A systematic review from 2005 5 also found that routine nasogastric decompression does not provide any benefits and should be abandoned in favor of selective use.
- A quasi-experimental study from 2009 6 found that nasogastric decompression does not provide added advantage after small bowel anastomosis, with longer hospital stays and more respiratory complications in patients with NG tubes.
Key Points to Consider
- The routine use of NG tubes after abdominal surgery does not provide significant benefits and may even lead to longer hospital stays and more complications.
- Selective use of NG tubes, based on individual patient needs, may be a more effective approach.
- Patients without routine NG decompression may have earlier return of bowel function and shorter hospital stays.
- The decision to remove an NG tube should be based on the patient's medical condition, symptoms, and ability to tolerate oral intake.