Management of Uncontrollable Nausea and Vomiting with NGT Leakage
For a patient with uncontrollable nausea and vomiting with brownish liquid leaking from the nasogastric tube (NGT), immediate management should include verification of proper NGT placement, gastric decompression, administration of antiemetics, and consideration of proton pump inhibitors to reduce gastric secretions. 1
Initial Assessment and Management
- Verify proper NGT placement immediately, as brownish liquid leakage could indicate misplacement or other complications 2
- Radiographic confirmation is the gold standard for verifying NGT placement before initiating any feeding or medication administration 1
- Point-of-care ultrasound can be used as an alternative method to confirm proper placement when radiography is not immediately available 3
- Ensure the NGT is functioning properly for gastric decompression by checking for patency and proper suction 1
Pharmacological Management
- Administer intravenous metoclopramide for relief of symptoms associated with gastric stasis, which can help with both the nausea/vomiting and improve gastric emptying 4
- Consider intravenous ondansetron for prevention and treatment of nausea and vomiting, especially when conventional treatments have failed 5
- Initiate proton pump inhibitors to decrease gastric acid secretion, which can minimize leakage and reduce irritation 6
- Consider adding prokinetic agents to improve gastric emptying if gastroparesis is suspected as a contributing factor 7
NGT Care and Management
- Ensure proper NGT securement to prevent dislodgement and minimize leakage around the insertion site 1
- For peristomal leakage, apply zinc oxide-based skin protectants to protect surrounding skin from irritation 6
- Use foam dressings rather than gauze around the insertion site to reduce local skin irritation, as foam lifts drainage away from the skin 6
- Check for proper tension between internal and external bolsters if applicable, as improper tension can lead to increased leakage 6
Addressing Potential Complications
- If respiratory distress develops, immediately suspect NGT misplacement in the respiratory tract and obtain urgent imaging 2
- Monitor for signs of aspiration pneumonia, especially in patients with impaired swallowing 1
- Evaluate for potential causes of uncontrollable vomiting, including mechanical obstruction, increased intracranial pressure, or medication side effects 1
- Consider replacing the NGT if occlusion is suspected, as this can contribute to inadequate decompression and persistent symptoms 8
Special Considerations
- Avoid unnecessary NGT use, as studies have shown an association between NGT insertion and poor clinical outcomes in certain conditions 6
- If long-term enteral access is anticipated (>4 weeks), consider more permanent options like percutaneous endoscopic gastrostomy (PEG) 1
- In ventilated patients, ensure proper cuff inflation of the endotracheal tube to minimize risk of aspiration 8
- For patients with gastroparesis, consider a trial of erythromycin which may improve gastric emptying 7
By following this structured approach to managing uncontrollable nausea and vomiting with NGT leakage, you can effectively address the patient's symptoms while minimizing potential complications.