Med-Surg Nursing. Do Anti-Reflux Valves work? Or are they "dangerous".

[maleAFnurse11]

I've been a nurse for 8 years and worked in a number of floors across the country. I've always been taught to use Anti Reflux Valves when using a Salem Sump NG Tube while a patient is receiving wall suction.

Last week a surgeon came into a room and lectured the nursing staff about how the anti reflux valves don't actually work and "there is no evidence to suggest they actually work right, and in my experience they actually clog up the salem port." The surgeon continued to say that this is the new standard of practice and has been for "years". I told her I hadn't seen any literature recently for my annual trainings and I've been across the nation working under GI and General Surgery MDs who have never told me that.

Does anyone have any information that would back up this surgeon? I'm not looking to pull a, "I told you so", I just want to make sure I'm following best practice.

[AceOfHearts<3]

Surgeons at my hospital don't like them, but I don't notice a difference. If the salem isn't draining with an anti-reflux valve on, it doesn't tend to drain without one either in my experience. The surgeons also aren't the ones dealing with messy sheets and patients when they leak...

No literature to back this up. Sorry.

[Wuzzie]

When one states that there are studies supporting one's position the onus is on the one to produce said studies. My suspicion is the surgeon is probably banking on his assumption that nurses do not understand research and are of the ilk who would never dare to question him. That being said the only time I have had a Salem Sump leak is when it has been changed from low continuous to low intermittent suction thereby allowing gastric fluids to reflux up the vent tube.

And FTR a quick Google Scholar search brought up only one study done in 1986 that actually supported their use.

[Night__Owl, BSN, RN]

Intermittent suction iirc is for tubes that don't sump. The sump end on the Salem Sump tunes is to keep the pressure off the stomach while it's empty. So you usually shouldn't need an anti reflux valve if you're using low continuous suction on the sump tube like it's designed for.

[K+MgSO4, BSN]

Can someone please explain the Salem Sump and suction to me.

In all the countries that I have worked in we use a Ryles tube on free drainage with 4 hrly aspirations i.e. every 4 hrs I disconnect the free drainage bag and aspirate the gastric contents with a 50ml catheter tip syringe until I can get nothing more back. At this time I would also empty the FD bag.

As the pt condition improves the tube would be spiggotted and aspiration every 4 hrs...if the pt was nauseated back on FD.

[Wuzzie]

Intermittent suction iirc is for tubes that don't sump. The sump end on the Salem Sump tunes is to keep the pressure off the stomach while it's empty. So you usually shouldn't need an anti reflux valve if you're using low continuous suction on the sump tube like it's designed for.

That's true but sometimes the sump lumen malfunctions and egads the mess they make until the problem is resolved.

[marienm, RN, CCRN]

A couple of our surgeons don't like them either and insist that they be removed. I usually wrap the end sump port in a chux pad...even on continuous low suction, gastric contents can and will come out this port! These same surgeons often write an order to flush the sump port with 30cc air every 6 hours. My understanding of the logic is thus: The sump port acts as a pressure relief so that even if the gastric end of the tube is pressed right up against the mucosa, the suction won't damage the tissue. Instead, air will just be pulled through the sump port. However, inside those anti-reflux valves is basically a coffee filter. If it becomes saturated, air can't get through it and the suction will be pulling directly on the tissue. Removing the valve completely eliminates the possibility of it clogging, and flushing the sump port with air can clear any bit of junk that could be clogging the port.