How long should an orogastric (OG) tube be hooked up to suction for an intubated patient?

Orogastric Tube Management in Intubated Patients

Nasogastric tube use should be considered on an individual basis, with daily reevaluation of the need for the tube, and it should be removed as early as possible to minimize complications. 1

Initial Placement and Confirmation

When placing an orogastric (OG) tube in an intubated patient:

1. Proper confirmation of placement is essential

   • Radiographic confirmation is mandatory before initiating any feeding or medication through the tube 2
   • Auscultation alone is unreliable and can lead to misinterpretation of tube position 2
   • A chest X-ray that includes visualization of the upper abdomen is the gold standard for confirmation 2

2. Timing of placement

   • For intubated patients requiring gastric decompression, place the OG tube soon after intubation
   • For those requiring enteral nutrition, feeding can begin within 2-4 hours after uncomplicated tube placement 1

Duration of Suction

The duration of OG tube suction should be guided by the following principles:

• Discontinue enteral tubes as soon as the clinical indications for these are resolved 1
• Daily reevaluation of the need for OG tube suction is mandatory 1
• Remove the tube as early as possible to reduce complications such as:
  • Mucosal damage
  • Infection risk
  • Patient discomfort
  • Potential for aspiration

Specific Recommendations Based on Clinical Scenarios

1. For gastric decompression in newly intubated patients:

   • Initial continuous suction for 24-48 hours
   • Daily assessment for continued need
   • Convert to intermittent suction when gastric residuals decrease

2. For patients at high risk of aspiration:

   • Continue suction until risk factors resolve
   • Elevate the head of the bed 30-45 degrees to reduce aspiration risk 1

3. For patients receiving enteral nutrition:

   • Assess intestinal motility regularly (bowel sounds, residual gastric volume)
   • Adjust feeding rate and volume to avoid regurgitation 1
   • Consider transitioning from continuous to intermittent suction once feeding is established

Complications to Monitor

1. Vomiting and aspiration

   • Higher risk in trauma patients with OG tubes (20.5%) compared to those receiving anti-emetics (2.7%) 3

2. Mucosal damage

   • Prolonged suction can cause mucosal irritation and bleeding

3. Tube displacement

   • Regular verification of tube position is necessary, especially after episodes of coughing or vomiting 2

Best Practices for OG Tube Management

• Use aseptic technique when handling the tube and suction equipment 1
• Change suction-collection tubing between patients 1
• Use only sterile fluid when clearing secretions from the suction catheter 1
• Apply the lowest effective suction pressure to minimize mucosal damage

When to Remove the OG Tube

Remove the OG tube when:

• The patient no longer requires mechanical ventilation
• Gastric decompression is no longer needed
• The patient can protect their airway and tolerate oral intake
• There are signs of complications from the tube

Remember that prolonged use of OG tubes is associated with increased risk of complications, and the clinical benefit must outweigh these risks. Daily assessment and documentation of the continued need for the tube is essential for optimal patient care.