Bloody NG Drainage

1. For serious upper GI bleeding, obtain IV access and start fluids. Hypotensive patients may require fluid and blood replacement. Transfer to ICU for careful monitoring.

2. Irrigate NG tube with room-temperature water. Avoid ice water lavage, which may contribute to tissue ischemia. Lavage probably will not stop bleeding but it can help clinician to assess status of bleeding. Lavage also clears the stomach of clots, making endoscopy more effective.

3. Medical therapy. Attempt to maintain gastric pH > 4. This may be accomplished by antacids, 0.5 mL/kg per dose (to maximum of 30 mL) every 2 hours. Vomiting patients may not tolerate antacids. Sucralfate, as a protective barrier, may be helpful. IV H2 blockers or PPIs may also be helpful. IV somatostatin analogues have been useful in patients with severe upper GI bleeding.

4. Consider upper endoscopy when bleeding persists.

5. Presence of peritoneal signs or new, free intra-abdominal air requires emergency laparotomy.

0 0

Post a comment