NGT on Upper GI Bleed?

[Claudia89139]

I'm reading materials regarding gastro and came across inserting an NGT as an appropriate intervention for possible Upper GI Bleed, s/p knee surgery. Given that we're ruling out Upper GI Bleed, wouldn't inserting an NGT might cause a trauma to a possible varice in the esophagus?? Shouldn't we insert a dub-hoff instead? have another instrument make sure we don't nick a varice, vein or something?

what do you think?

[Biffbradford]

I wouldn't put one in and I can't think of any Docs that would order it.

[ckh23, BSN, RN]

Does the patient actually have varices? Or is just a concern for putting in the NGT? If they do have varices that are bleeding and that is the source of the UGI bleed than you would more commonly see a Blakemore tube instead of an NGT. A dobbhoff wouldn't do you any good because it is so small you won't be able to decompress the stomach.

If they do have varices and their UGI bleeding is from other source, the primary intervention will most likely be medical and non invasive.

[Biffbradford]

Back when I first started in the ICU some dozen years ago, I recall a patient admitted for bleeding esophageal varies. It wasn't my patient, but I recall a LOT of people in that room and them hanging LOTs of PRBCs. I believe he died.

[silentRN]

We have NGT made of a softer material for patients with varices, and we always ask the MD to place them.

[Claudia89139]

Thank you for all the input.

I agree with all of you on the contra-indication of NGT for UGI-Bleed.

I am looking up Blakemore tube, I've never seen one nor is it being used in our unit.

I don't think our unit carries any other kind of NGT that is of softer material that wou be beneficial for esophageal/UGI bleeding patients. Something to talk about on our next staff meeting.

:)

[lotosho]

I guess you have to look at the big picture, if you dont place some sort of tube to divert the blood from just sitting in the gut, it could causes other issue. I have heard of the blakemore tube but never used or placed one. The ultimate goal is determining where the bleed is and what cause it and how to stop it. Treat the signs as they present and to keep the patient hemodynamically stable.

[worked hard and long]

Blakemore tube is a multiport type NGT to place pressure on KNOWN actively bleeding esophogeal varices. A simple NGT that can come in various sizes is used to decompress the stomach with LOW intermitant suction to evacuate and evaluate stomach contents. The bleed may be in one of the three areas of the stomach. Is it better that the patient vomit creating increase intrathoracic pressure repeatedly possibly creating more bleeding.

[MaMaMia1016]

pt would be npo if they have gi bleed, so reason for ngt would be for low intermittent suction to decompress the stomach. dubhoff wouldnt do anything as it's lumen is too small for suction.

[blucrna]

I've seen NG tubes to low intermittent suction for GI bleeds a couple of times on my unit. More often they have a sandistatin drip going though. heck even sometims both depending on the severity of the bleed.

[8mpg]

We put NG tubes in all the time with upper gi bleeds. They are low int suction. Often if the bleeding has slowed, we lavage them and see if its still bleeding. Also to rule out upper gi bleeds we put in NG tubes to lavage.