Salem Sump NG Tubes

meownsmile, BSN, RN · Mar 2, 2005

Not really sure what he was giving you heck for. If you place a tube on the unit, you will usually get a good return on stomach contents as soon as you are in the stomach. An air bolus should be used each time you access the NG, but on first time uses if you have no stomach contents returned and you have no reason to feel it isnt in the stomach, you should get a x-ray for placement rather than put the patient through more manipulation of the tube just because it might not be where its supposed to be. If it goes down the trach youll usually know pretty quickly.

Make sure you measure properly before you try to insert it. Be generous with water for the patient to drink as you insert the tube. Use your syringe to aspirate if you need to for finding placement. And by all means attach a 30ml syringe to the tube BEFORE you attempt insertion. Or you may find just how fast someone can become a fountain. When in doubt get an x-ray.

stevierae · Mar 2, 2005

Isn't X-ray REQUIRED by JCAHO now after placement of ANY NG tube? I thought I remember reading that just recently. We never do so in the O.R. though.

RN-PA, RN · Mar 2, 2005

stevierae said:
Isn't X-ray REQUIRED by JCAHO now after placement of ANY NG tube? I thought I remember reading that just recently. We never do so in the O.R. though.

An Xray is REQUIRED by JCAHO??? You've got to be kidding. I'd love to know if anyone else has heard this!

UM Review RN, ASN, RN · Mar 2, 2005

I don't know if verification of placement is required by JCAHO, but our hospital does require it. Until confirmation, we only check placement with an air bolus. Sometimes the X-ray will come back with a recommendation like, "The tube is in the upper fundus of the stomach, suggest advancing another 4 inches" or something like that.

And I have a question about Salem sumps too. Years ago, I was told to leave the blue tube open in order for the NG to function properly with suction. Lately I always see the blue part of the tubes plugged.

Should it be plugged or open? If open, what do you do about drainage that keeps flowing through the blue part of the tube?

PS To the OP: this is a great place to learn things, but I wouldn't get all upset about the situation. One of our GI docs actually ordered us to check residuals on a Dobhoff q4h. I was taught that you can't check residuals on a Dobhoff. So if I'm wrong, feel free to correct me.

URO-RN · Mar 2, 2005

I encountered this problem once. Turns out it was the sx on the wall that was defective.

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Argyle Salem Sump Tubes

Double lumen PVC tube- one for suction drainage and one for sump vent. X-ray opaque Sentinel Line with Sentinel Eye. Integral funnel connector with removable 5-in-1 adapter. Integral irrigation funnel for irrigating through sump vent lumen. Funnel end of vent lumen can be used to cap 5-in-1 adapter. Packaged sterile.

unknown99, BSN, RN · Mar 3, 2005

RN-PA said:
An Xray is REQUIRED by JCAHO??? You've got to be kidding. I'd love to know if anyone else has heard this!

Never heard that either. At least it is not required in Ohio.

unknown99, BSN, RN · Mar 3, 2005

Angie O said:
And I have a question about Salem sumps too. Years ago, I was told to leave the blue tube open in order for the NG to function properly with suction. Lately I always see the blue part of the tubes plugged.
Should it be plugged or open? If open, what do you do about drainage that keeps flowing through the blue part of the tube?
.

A salem sump should have the blue tube open in order to function the way they are intended to function. It should not be plugged unless there is a specific order to do so. Usually when a doctor orders it plugged, they are checking to see if the GI tract is non-functioning to to air. The blue tube is an air vent.

SharonH, RN · Mar 3, 2005

Angie O said:
PS To the OP: this is a great place to learn things, but I wouldn't get all upset about the situation. One of our GI docs actually ordered us to check residuals on a Dobhoff q4h. I was taught that you can't check residuals on a Dobhoff. So if I'm wrong, feel free to correct me.

Yep, you can and should.

Edited to add: you're probably thinking of a J-tube.

Fluesy · Mar 3, 2005

Angie O said:
I don't know if verification of placement is required by JCAHO, but our hospital does require it. Until confirmation, we only check placement with an air bolus. Sometimes the X-ray will come back with a recommendation like, "The tube is in the upper fundus of the stomach, suggest advancing another 4 inches" or something like that.
And I have a question about Salem sumps too. Years ago, I was told to leave the blue tube open in order for the NG to function properly with suction. Lately I always see the blue part of the tubes plugged.
Should it be plugged or open? If open, what do you do about drainage that keeps flowing through the blue part of the tube?

You are correct. Theorectically (as opposed to reality lol) the air is supposed to be sucked down the blue tube and up the clear tube, which should stop the suction ports in the clear tube sucking up against the stomach wall and causing erosion. We have one way valves for our Salem's that stop the gastric fluid draining all over the sheets while still allowing for the air to do it's thing.

OF course theorectically the one way valves are not needed - if the system is working the blue tube will not drain gastric fluid............. Yeah Riiiiiiiiight!

jaimealmostRN · Mar 3, 2005

New grad warning here, this is just what I remember reading about Salem sump. The blue vent should always be open, esp. if on suction b/c it prevents the tube from sucking the stomach lining and damaging it. If the blue tube is draining (which it shouldn't be) you can flush with air (not sure about water) to get the suction back on track - coming out the clear tube. I think the only time the blue can be tied off, is if the salem sump is not being used for suction at the present time. My $0.02 :)

heartICU · Mar 3, 2005

annmariern said:
Hi,
Had a bad time with these things the last few days and wanted to get more info on them. Had a doc tell me about relying on flushing the anti reflux valve with air to determine placement as opposed to relying on the x-ray. would have liked to have asked much more, but was getting my butt kicked at the time ( sure you all know that story), so would like a quick inservice from people much more familiar with them. appreciate your help.

Do you get routine xrays on patients with an NG or OG? It doesn't seem to be cost-effective when there are other ways of determining placement, like air bolus or checking pH of the aspirated fluid. At my institution, our policy was to check the pH of the aspirated fluid.

(As a side-note, the anti-reflux valve has air vents in it to allow for air to move in and out, but it also prevents the stomach sludge from coming up).