Risks of Placing a Nasogastric Tube on High Suction
High suction on a nasogastric tube can cause significant tissue damage, mucosal erosions, and potentially life-threatening complications including gastric perforation, hemorrhage, and aspiration.
Potential Complications of High Suction with NG Tubes
Immediate Tissue Damage
- Mucosal injury and erosions from direct trauma when high suction pulls gastric mucosa against tube openings 1
- Nasopharyngeal discomfort which is already common with NG tubes and worsened by high suction 1
- Nasal erosions that can progress to abscess formation with prolonged high-pressure suction 1
Serious Complications
- Gastric perforation when high suction force pulls gastric wall tissue into tube openings
- Bleeding from damaged mucosa, which can range from minor to significant hemorrhage
- Esophagitis and ulceration from local abrasion exacerbated by high suction 1
- Fistula formation between the esophagus and trachea, particularly with larger tubes and high suction 1
Physiological Consequences
- Electrolyte imbalances from excessive fluid removal
- Dehydration from rapid removal of gastric contents and fluids
- Acid-base disturbances from loss of gastric acid
Appropriate NG Tube Management
Suction Recommendations
- Use low intermittent suction rather than continuous high suction
- For gastric decompression, use the minimum effective suction level
- Monitor suction pressure regularly to ensure it remains at appropriate levels
Patient-Specific Considerations
- Higher risk patients include those with:
- Recent gastric surgery
- Gastric varices
- Coagulopathies
- History of gastric ulcers
- Patients who have undergone gastric bypass (risk of Roux limb perforation) 2
Proper Technique
- Ensure proper tube placement before initiating any suction 3
- Verify tube position with X-ray or pH testing before use 3
- Use appropriate tube size - smaller tubes (8 French) for feeding, larger only when decompression is necessary 3
- Consider alternatives to NG tubes for long-term decompression (>4 weeks), such as gastrostomy tubes 4
When NG Tube Decompression Is Indicated
Despite risks, there are specific situations where NG tube decompression is beneficial:
- Patients undergoing rapid sequence intubation (RSI) who are at high risk of regurgitation 1
- Patients with gastric distention confirmed by clinical assessment or point-of-care ultrasound 1
- Patients with estimated gastric fluid volume >1.5 mL/kg or presence of solid gastric contents 1
Best Practices to Minimize Complications
- Regular assessment of continued need for NG tube and suction
- Proper tube care including repositioning and checking patency
- Monitoring for complications such as bleeding, pain, or signs of perforation
- Consider early removal when the clinical indication resolves 5, 6
- Avoid routine postoperative NG decompression as it increases risk of fever, atelectasis, and pneumonia 3
Remember that routine use of NG tubes with suction does not necessarily improve outcomes and should be used selectively based on specific clinical indications rather than as standard practice 7.