[Preemienurse23]

I had a kid who was 6 days post surgery to reverse his ostomy. He was on the vent for 5 days (don't get me started on the nurse who had him for 4 days...she scares me a lot!) I had him day 6 post op. Nights had 40 output from his sump, and then I wound up having 160+cc from 7a-3p. I notified the MD of the large amount, and the color went from the lovely green, to clear to coffee grounds. Towards the end of the shift, I begin to get get fresher blood, not bright red, but still redder than coffee ground colored. I notified the NNP and was pretty much blown off. I was always taught that its was a fairly alarming situation. I also know that the sump was probably irritating his stomach, but it was still concerning to me. Should I have been that concerned? I didn't expect him to come running over, but being blown off didn't help my confidence any. One of our Neos did happen to walk by and ordered meds.

[SteveRN21]

They shouldn't have blown you off in any case....

How high was the suction pressure set? I often find that when a replogle starts to pull out blood/clots, that the suction pressure is set too high, which could cause gastric bleeding.

Usually if the kid is acting ok, I'll drop the suction to 30-40mmHg, irrigate the tube w/ a little NS, and call the neo/NNP to get a Zantac or Prevacid order, if it's not already in the TPN. It usually does the trick.

[Preemienurse23]

Sxn was on 80 mmHg. I wasn't getting any clots, just thick stringy secretions that kept blocking up my connections. It may have been up against the wall, but that I don't know. We did get him some previcid and It should have been added to HAF the next day.

[elizabells]

Our protocol for replogle to LWS is sxn between 40-60, so that may have been your issue. I've definitely seen scary red blood come out when the sxn is too high and miraculously clear up once you drop it to 40-45.

[SteveRN21]

Yeah.... 80mmhg is WAY too high. That what your airway suction should be set on. If you need to set it that high to get aspirates, you need to start irrigating/manually gently aspirating the replogle with 1-2 cc NS every couple of hours.