Intermittent Low Wall Suction Rate for Small Bowel Obstruction
For nasogastric tube decompression in small bowel obstruction, use intermittent low wall suction set at 40-80 mmHg (typically 60 mmHg), cycling on for 15 minutes and off for 15 minutes, though the specific technical parameters are less critical than ensuring adequate gastric decompression while minimizing mucosal trauma. 1
Rationale for Intermittent Low Suction
Intermittent suction prevents mucosal injury that can occur with continuous high-pressure suction, which may cause gastric wall adherence to suction ports and tissue damage 1
Low wall suction (40-80 mmHg) provides adequate decompression while minimizing the risk of mucosal trauma and maintaining tube patency 1
The cycling pattern (typically 15 minutes on/15 minutes off) allows the gastric mucosa to recover between suction periods and prevents the tube from becoming adherent to the stomach wall 1
Clinical Application
The primary goal is gastric decompression to prevent aspiration and reduce proximal bowel distention, not the specific suction parameters 2, 1
Monitor NG tube output volume rather than fixating on exact suction settings - output less than 10cc over 14 hours suggests adequate decompression and potential for tube removal 3
Daily evaluation of NG tube necessity is recommended, as prolonged use increases complications without improving outcomes 3
Common Pitfalls to Avoid
Do not use continuous high suction, as this significantly increases the risk of gastric mucosal injury and bleeding 1
Do not delay tube removal once output decreases and bowel function returns (passing flatus or stool), as prolonged placement increases aspiration risk and patient discomfort 3
Ensure the tube is properly positioned in the stomach before initiating suction - malpositioned tubes in the esophagus can cause significant mucosal damage 1