Here's the scenario - "Otherwise healthy" young person with UGI bleed from suspected NSAID overuse came up from ER with NG that they'd already had to do a 1000cc lavage on. I have it to LIS as ordered,- and make sure it's on low. Next time I'm in the room the guy has 200cc dark blood in his gomco and I noticed the suction was kicking up all the way to the highest high when it would turn on. I didn't want it sucking up this guy's gut tho. I disconnect & irrigate the distal tubing thinking it's too thick, and replace the old model dial suction control with a digital one, hoping to gain more control & keep it in the low suction range.
In my head I'm thinking... it kicked up to full because it was working against clots (like sucking a milkshake straw that has a strawberry chunk blocking it - ya know?) I tell the pt to call at first inkling of any nausea & literally 5 min later he's vomiting clots. I medicate for nausea and my nrsg supervisr was on the floor so I asked her help. She tried to irrigate toward pt & repositioning NG a little...she could get some water into the pt. but couldn't get it back... all clots. Had me call admitting physician to let him know we can't keep the NG patent due to large amt of clots. Admitting doc has me contact the GI consult that hasn't seen him yet - because it's the middle of the night. GI consult gets mad that he had an NG to begin with and bothered him... Said "just pull the **** NG that shouldn't have been put in to begin with and keep him medicated for nausea." (Didn't seem concerned about the amount of bleeding.)
Okay so here's my question: When an NG won't stay on low intermittent suction d/t clots and you can't stand 1:1 all night to watch it or continually irrigate it -- what could I have done differently? I didn't feel right leaving it the way it was kicking to high each time but knew low wasn't going to cut it either.
Another nurse said she's had the same thing happen with a clotty bleed.
Thanks for any advice for next time.
BTW, pt was delighted to have the NG taken out and never vomited again.
azhiker96, BSN, RN
1,130 Posts
Excellent question. I'd have to defer that to a GI doc. I sure don't know the answer.