Nasogastric suction

Emesis basin, nasogastric suction units—Visually check the nasogastric suction unit every 2 to 4 hours and when the unit is emptied. Check the emesis basin each time it is emptied. 

In some situations, electrolytes are administered when an electrolyte imbalance may potentially occur. For example, the patient with nasogastric suction is prescribed one or more electrolytes added to an IV solution, such as 5% dextrose or a combined electrolyte solution, to be given IV to make up for the electrolytes that are lost through nasogastric suction. In other instances, electrolytes are given to replace those already lost, such as the patient admitted to the hospital with severe vomiting and diarrhea of several days duration. 

Excessive sweating, osmotic diarrhea, vomiting, nasogastric suctioning, and respiratory... 

Vomiting, nasogastric suctioning, and chloride (secretory) diarrhea (villous adenoma or laxative abuse)... 

Medications aimed at decreasing pancreatic enzyme release (e.g., somatostatin), nasogastric suction, and anticholinergic medications have all failed to show benefit in the treatment of acute pancreatitis. 

In general, contributing factors such as diuretics, nasogastric suction, and corticosteroids should be discontinued if possible. Any fluid deficits should be treated with IV normal saline. Recognize that patients with varieties of metabolic... 

In patients with peritonitis, hypovolemia is often accompanied by acidosis, so large volumes of a solution such as lac-tated Ringers may be required initially to restore intravascular volume. Maintenance fluids should be instituted (after intravascular volume is restored) with 0.9% sodium chloride and potassium chloride (20 mEq/L) or 5% dextrose and 0.45% sodium chloride with potassium chloride (20 mEq/L). The administration rate should be based on estimated daily fluid loss through urine and nasogastric suction, including 0.5 to 1.0 L for insensible fluid loss. Potassium would not be included routinely if the patient is hyperkalemic or has renal insufficiency. Aggressive fluid therapy often must be continued in the postoperative period because fluid will continue to sequester in the peritoneal cavity, bowel wall, and lumen. 

Metabolic alkalosis is initiated by increased pH and I ICC)3, which can result from loss of H+ via the GI tract (e.g., nasogastric suctioning, vomiting) or kidneys (e.g., diuretics, Cushing s syndrome), or from gain of bicarbonate (e.g., administration of bicarbonate, acetate, lactate, or citrate). 

Peristalsis Ondansetron does not stimulate gastric or intestinal peristalsis. Do not use instead of nasogastric suction. Use in abdominal surgery may mask a progressive ileus or gastric distension. 

Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable. 

A 64-year-old woman started to take oral haloperidol 0.5 mg tds, and 3 days later was given intravenous benzatropine 2 mg for dystonia plus a second dose 1 hour later because she had not responded to the first dose. Her dystonia improved, but she started to develop abdominal distension and discomfort, and within the next 3-4 hours her whole abdomen had become significantly distended. Haloperidol and benzatropine were withdrawn and she was treated with hydration, nasogastric suction, a rectal tube, and frequent change of position. With this conservative therapy, her abdominal distension resolved completely in 24 hour. 

Supportive care may include hydration, enteral tube or parenteral nutrition, nasogastric suctioning for ileus, bowel and bladder care, prevention and treatment of decubitus ulcers, prevention and treatment of deep venous thromboses, intensive care, mechanical ventilation, treatment of secondary infections, and monitoring for impending respiratory failure (36,38). 

Treatment of PCP toxicity is supportive. Severe agitation or seizures may respond to diazepam severe psychoses may require a neuroleptic drug, such as haloperidol. " For the most serious cases, continuous nasogastric suction to help remove PCP may be beneficial urine acidification to hasten eEmination has been advocated by some but is controversial. ... 

Prolonged vomiting or nasogastric suction Pyloric or upper duodenal obstruction Prolonged or abusive diuretic therapy (loop diuretics) Villous adenoma Posthypercapnic state... 

GI, vomiting, and nasogastric suction may deplete body stores of magnesium as upper GI fluids contain approxi-... 

Prolonged nasogastric suction Malabsorption syndromes Extensive bowel resection Acute and chronic diarrhea Intestinal and biliary fistulas Protein-calorie malnutrition Acute hemorrhagic pancreatitis Primary hypomagnesemia (neonatal)... 

Respiratory alkalosis and metabolic alkalosis Example Hepatic failure and diuretics Patients on ventilation given nasogastric suction... 

Vigorous fluid resuscitation and support of respiratory, renal, cardiovascular, and hepatobiliary function may limit systemic complications. " However, there is no proven method to prevent these complications. While hemoconcentration (decreased intravascular volume) is strongly associated with pancreatic necrosis, it is not clear whether aggressive fluid resuscitation alone during the first 24 hours can prevent pancreatic necrosis." Procedures such as ERCP, hypothermia, nasogastric suction, pancreatic irradiation, peritoneal lavage, and thoracic duct drainage remain unproven. ... 

Potassium-rich foods often cannot completely replace potassium associated with chloride losses (vomiting, diuretics, or nasogastric suction) because it is almost entirely coupled to phosphate. Furthermore, increasing dietary intake of these foods may lead to unwanted weight gain. 

Excessive vomiting Prolonged nasogastric suction Excessive laxative use Intestinal and biliary fistulas... 

Loss of gastric acid from vomiting or nasogastric suction- ing is often responsible for the development of a metabolic alkalosis, characterized by hypochloremia and hyperbicar-bonatemia. 

The combination of respiratory and metabolic alkalosis is the most common mixed acid-base disorder. This mixed disorder occurs frequently in critically ill surgical patients with respiratory alkalosis caused by mechanical ventilation, hypoxia, sepsis, hypotension, neurologic damage, pain, or drugs, and with metabolic alkalosis caused by vomiting or nasogastric suctioning and massive blood transfusions. It may also occur in patients with hepatic cirrhosis who hyperventilate, receive diuretics, or vomit, as well as in patients with chronic respiratory acidosis and an elevated plasma bicarbonate concentration... 

Aggressive fluid repletion and management are required for successful treatment of intraabdominal infections. Fluid therapy is instituted for the purposes of achieving or maintaining proper intravascular volume to ensure adequate cardiac output, tissue perfusion, and correction of acidosis. Loss of fluid through vomiting, diarrhea, or a nasogastric suction contributes to dehydration. Intravascular volume can be assessed by blood pressure and heart rate but more accurately... 

Nasogastric suction Ostomy/fistula drainage Diarrhea Glycosuria Phototherapy... 

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