NGT Feeds vs Suction

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Specializes in ICU/Critical Care.

Hello! Had a question maybe some of you guys could help me with as I prepare for my NCLEX exam thats coming up Anyways, when answering questions related to NGT, some are never specified if the tubing in is pace for decompression or nutrition, making it really difficult answering the question.

For example: A client has a nasogastric tube in place after extensive abdominal surgery. The client complains of nausea. The nurse notes the client's abdomen is distended and there are no bowel sounds. Which of the following actions should the nurse take FIRST?

None of the answers gave a hint as to whether it was tube feeds or to suction. Now cause it was an 'extensive surgery,' I'm assuming it was hooked up to suction, but how do I know? I guess my question is what type of patients should I suspect on suction, as I know tube feeds are for those who need supplemental/full nutrition for various reasons. Hoping I worded this correctly to get my confusion across! I appreciate any and all help, thank you in advance!!! :)

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Specializes in multispecialty ICU, SICU including CV.

It would be helpful if you gave the answers to the NCLEX question above. We could help you sift through what is incorrect and the rationale as to why. I would not make any assumptions that this tube was to suction or had feeds infusing based on the way the question was asked. My guess is that they are trying to tell you that the patient has a tube and it is clamped/dormant.

FIRST nursing action in all these NCLEX clinical situations is always assess, or ABCs. This question gives you a partial assessment, so you need to go from there. If this is a dormant NGT, obvious answer would be to hook it up to suction.

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Specializes in ICU/Critical Care.

1. Administer the PRN pain medication and an antiemetic.

2. Irrigate the nasogastric tube with normal saline.

3. Determine if the nasogastric tube is patent.

4. Check the placement of the nasogastric tube by auscultation.

I was torn between 2 & 3, answer 3 was correct HOWEVER The rationale for it not being 4 was "patency should be checked first by aspirating stomach contents, not by auscultation" which to me seem weird because I was always taught that auscultating would identify correct placement. If someone had been properly digesting their feeds (of course I dont mean this pt), there would be no residuals which then tells you nothing about where it is. Am I wrong? I, of course, am no expert so I don't know. Anyway, this is not the only question about an NGT that I have had that knowing whether it was feeds or suction would have changed my answers but it never specified or gave hints. Thank you for responding!

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Specializes in Critical Care.

In this situation, the NG would be to suction. At least it should be.

When you separate the indications for either feeding or suction, you can figure out which best fits the scenario.

Suction is used for emptying the stomach contents. This is appropriate when someone has had abdominal surgery and has not resumed bowel motility. Or if there is an ileus or bowel obstruction also interfering with motility. When a patient's level of consciousness suggests that airway protection is an issue in the context of vomiting, an NG or OG is placed. This includes intoxicated patients. In fact, it chaps my hiney to receive an intubated intoxicated patient from ED with no NG/OG. Anyway....

Tube feeding via NG is only appropriate as a temporary means in providing nutrition to patients who due to level of consciousness issues (including sedative medications) or who due to any number of reasons cannot safely swallow without aspirating. In the cases in which the LOC and/or swallowing problems are not expected to resolve, the next move is to place a G, or J, or G/J tube for long term nutrition needs.

That's pretty straightforward, right? In the real world things are more complicated. You can have a person with history of CVA that is s/p abd. surg. That person may have initially had the NG placed for surgical reasons, but by the time GI motility has returned, may still be too groggy with pain medications, etc. to safely try a swallow eval. So nutrition may be started (gradually) to meet metabolic needs until that patient's condition changes.

Keep in mind that you wouldn't start TF for a patient with no bowel sounds. And if a patient is on TF and you assess their abdomen and it as absent of bowel sounds and is distended, and the person is nauseated and or vomiting, you'd stop the TF and hook the tube back up to suction and then notify the physician.

If (as is most likely the case in your scenario) the NG is already hooked up to suction and the patient is c/o nausea, you'd check to make sure that the NG is in the correct position, that it is patent, and that the suction is turned on! If there isn't any output you'd confirm placement, try a gentle irrigation, try to manually aspirate- trouble shoot your equipment. Some people still feel queasy even when the suction is working fine. Likely this patient has an anti-emetic ordered. If none of these interventions help, notify the physician.

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Specializes in Critical Care.

The correct first intervention is #4, and then #3, then #2, and then depending on what happens, #1.

Except you would use water to irrigate unless you have a specific order to use NS.

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Specializes in Critical Care.
1. Administer the PRN pain medication and an antiemetic.

2. Irrigate the nasogastric tube with normal saline.

3. Determine if the nasogastric tube is patent.

4. Check the placement of the nasogastric tube by auscultation.

I was torn between 2 & 3, answer 3 was correct HOWEVER The rationale for it not being 4 was "patency should be checked first by aspirating stomach contents, not by auscultation" which to me seem weird because I was always taught that auscultating would identify correct placement. If someone had been properly digesting their feeds (of course I dont mean this pt), there would be no residuals which then tells you nothing about where it is. Am I wrong? I, of course, am no expert so I don't know. Anyway, this is not the only question about an NGT that I have had that knowing whether it was feeds or suction would have changed my answers but it never specified or gave hints. Thank you for responding!

Ideally, you could try aspirating first, however, you're right, it's possible that you could get nothing. If that's the case, attempt to confirm by auscultation. If you've confirmed that the tube placement is correct you could try irrigating. And however, whatever NCLEX is teaching these days- neigher auscultation, not aspirating contents are completely reliable in comfirming placement. That has been studied and recently published. The gold standard is still Xray. Which doesn't mean that you have to do an X-ray with every assessment, but with the initial insertion and if there is any doubt, you should get an order for a confirmatory xray prior to putting anything down the tube- including irrigating it. However, if I have a patient who comes up from the ED intubated without an NG/OG. I'll insert one, initially checking by aspirating/auscultating. If I'm confident that the tube is in the right place, I'll hook up to suction, order the xray. But, if the patient has an AM Xray ordered, I can safely wait a couple of hours for the routine xray. However, I would not put anything down that tube until I got xray confirmation. Sorry, kind of convoluted.

If the NCLEX scenario were real life and this lady had prior xray confirmation of placement and the tubing markings/adhesive tape etc were all intact and if I got nothing back from aspiration and got a clearly positive "bubble" from plunging air, I would try irrigating it. If that re-established patency and the patient was still nauseated I'd see what I could give her medically to treat that. If all the above failed, I'd notify the physician. I would also incidentally make sure the patient is positioned at least semi-upright >30 degrees and slightly turned to the side if tolerable AND have another suction and yankauer set up in case she hurls anyway. If I was a total rockstar on top of my game, I'd also have chucks across her chest and a plastic gown and face shield on while I was fooling around with the suction equipment. :p

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Specializes in multispecialty ICU, SICU including CV.

I think this is a crummy question and confusing. From the choices of answers, it looks obvious to me that the NG tube is to suction, although I believe they should have stated that in the question itself. Most patients with major abdominal surgery have an NGT to suction, but it isn't a given once they are getting closer to discharge. I hate questions where you have to make assumptions.

If this tube was to suction, then yes, #3 is correct. You should look at the tube/cannister and make sure the suction is working and there are stomach contents coming out. This is a really obvious step that would be very easy to overlook when choosing an answer, however.

You can sift through this with your test taking strategies though. #3 is an assessment, #1 and #2 are clearly interventions. I can see the NCLEX people making the argument that you should check to see if you can get anything OUT of the tube as opposed to infusing anything IN (as #4 suggests) for safety reasons. That didn't appear to be the rationale they used, however.

And FYI YES, you are correct that air auscultation is the best way to verify gastric tube placement -- evidence based studies have confirmed this. Good to know it is being taught this way in school now. Some places I have practiced still check pH of gastric contents.

OP, if you are thinking this hard, you will pass NCLEX. There are going to be some crummy questions on it. I would chalk this up to one of those. Missing a few bad ones isn't going to kill your score.

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Specializes in Med/Surg, Ortho, ASC.
The correct first intervention is #4, and then #3, then #2, and then depending on what happens, #1.

Except you would use water to irrigate unless you have a specific order to use NS.

OP states that #3 is correct, according to NCLEX.

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Specializes in Critical Care.
OP states that #3 is correct, according to NCLEX.

Yeah, I read that after I posted my reply. I think the choices are a little misleading. Guess I'm rusty with the NCLEX mentality since it's been 6 years since I've taken it.

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Specializes in NICU.

I'm thinking it's because when you check placement by auscultation, you're assuming that the tube is patent (i.e., that an air bolus will make it all the way through to the stomach). Therefore, since there's an option questioning the patency of the tube, that would have to be your first choice.

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Specializes in Critical Care.
I'm thinking it's because when you check placement by auscultation, you're assuming that the tube is patent (i.e., that an air bolus will make it all the way through to the stomach). Therefore, since there's an option questioning the patency of the tube, that would have to be your first choice.

Injecting an air bubble (or not being able to inject one, for that matter) tests patency. I would still attempt to manually aspirate first to avoid adding more to an already distended stomach. If you attempt to aspirate and don't get anything back it doesn't provide you with any information whether the tube is patent or in the right place. Injecting air and auscultating a bubble gives you generally reasonable certainty that the tube is in the right place and patent. However, you can still have sluggish evacuation which may improve after irrigating. That's just my thought process. I don't worry whether that jives with NCLEX or not. When you're studying for the test, definitely attune yourself to NCLEXisms but get ready to switch your thinking gears when you hit the real world.

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Specializes in MICU/SICU.

This is simple process of elimination.

#1 is wrong because there is no indication for pain meds.

#2 is wrong because you wouldn't irrigate with NS. (Personally, I wouldn't irrigate a big belly surgery AT ALL without talking to the MD first.)

#3 - nothing to make it wrong.

#4 - is wrong because auscultation is NOT a reliable indicator of placement http://classic.aacn.org/AACN/practiceAlert.nsf/Files/VOFTP/$file/Verification%20of%20Feeding%20Tube%20Placement%2005-2005.pdf

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