What is the maximum recommended nasogastric (NG) intermittent suction output in 24 hours?

Maximum Recommended NG Intermittent Suction Output in 24 Hours

There is no specific maximum limit for nasogastric (NG) intermittent suction output in 24 hours, as the appropriate management depends on monitoring the patient's clinical status rather than adhering to a predetermined volume threshold.

Indications for NG Tube Placement and Suctioning

• Fine bore (5-8 French gauge) nasogastric tubes should be used for enteral tube feeding unless there is a need for repeated gastric aspiration or administration of high viscosity feeds/drugs via the tube 1
• NG tubes can be placed on the ward by experienced medical or nursing staff, with position checked using pH testing prior to every use 1
• Suctioning should be performed only when necessary rather than on a scheduled basis 2

Monitoring and Management of NG Suction Output

• Close monitoring of fluid, glucose, sodium, potassium, magnesium, calcium, and phosphate status is essential in the first few days after initiating enteral tube feeding or when using NG suction 1
• Fluid needs can usually be met by giving 30-35 ml/kg body weight, though allowance must be made for excessive losses from drains, fistulae, etc. 1
• When managing patients with NG suction, focus should be on:
  • Maintaining euvolemia with appropriate fluid replacement 1
  • Monitoring for electrolyte imbalances 1
  • Assessing the patient's clinical status rather than focusing solely on output volume 2, 3

Complications Associated with NG Suctioning

• Potential complications of prolonged or excessive NG suctioning include:
  • Fluid and electrolyte imbalances 1
  • Nasal erosions, abscess formation, sinusitis, and otitis media from local pressure effects 1
  • Oesophagitis and ulceration from local abrasion 1
  • Pain and nasal bleeding 4

Best Practices for NG Suctioning

• When suctioning is required:
  • Apply suction for a maximum of 15 seconds per suctioning procedure 2, 3
  • Use the lowest possible suction pressure to effectively remove secretions 2, 3
  • For adult patients, suction pressure should be kept below -200 mm Hg 2
  • Avoid saline lavage during suctioning 2, 3
  • Use aseptic technique during open suctioning 2

Practical Considerations

• Both closed and open suction systems may be used to safely and effectively remove secretions 2
• Suction catheters should occlude less than 50% of the endotracheal tube lumen in adult patients 2, 3
• Higher suction levels lead to increased fluid output, as demonstrated in chest drain studies 5
• For oropharyngeal secretions in intubated patients, a minimum frequency of suctioning every 4 hours is recommended, though some patients may require more frequent suctioning 6

Rather than focusing on a specific maximum volume threshold for NG suction output, clinicians should prioritize monitoring the patient's overall clinical status, maintaining fluid and electrolyte balance, and addressing the underlying condition necessitating NG suctioning.