Ileus Clinical Trial
Official title:
Nasogastric Tube Clamping Trial: Is it Useful? A Proposed Algorithm for Removal.
The primary objective is to assess the need of clamping nasogastric tubes (NG) before
removal. Outcomes of patients admitted requiring nasogastric tube decompression will be
compared. Patients with small bowel obstruction (SBO), post-operative ileus, and ileus on
admission that require nasogastric tube placement will be included in the study. The patients
will be divided into two groups when return of bowel function is suspected based on set
criteria for automatic removal of nasogastric tube versus nasogastric tube clamp trial.
Specific outcomes will be occurrence of nasogastric tube replacement, number of emeses if
any, failure of clamp trial, aspiration pneumonia, and any other unplanned outcome.
A high volume of patients are admitted to hospitals yearly for bowel obstruction/ileus
complications. Lifetime risk of small bowel obstruction varies from 0.1%-5% if patients have
not undergone abdominal surgery, but increases to 30% if the patient underwent a prior
abdominal surgery. Ileus is also a common complication in the short term post-operative
period. Both of these conditions are initially treated with nasogastric tube decompression if
the patient is having emesis.
The investigators were unable to find any literature that shows a concrete volume of
nasogastric tube output that was deemed the maximum for safe removal. Signs of return of
bowel function can indicate it is safe to remove the nasogastric tube. These include flatus,
bowel movements, decrease in nasogastric tube output amount, change of nasogastric tube
output color from bilious (green) to more gastric (yellow) or salivary (clear/foamy) quality.
Some physicians prefer to perform a clamp trial before removal of the nasogastric tube. The
duration of the trial and cutoff amount of residual drainage varies among physicians.
Regardless of the duration, the nasogastric tube is essentially stenting open the lower
esophageal sphincter while it is left in place and not connected to suction. This,
theoretically, places the patient at risk for aspiration and subsequent pneumonia.
Information in the literature appears divided in regard to aspiration risk.
This study hopefully will support the statement that it is safe to remove the nasogastric
tube with signs of bowel function, without the need for clamp trials and thus avoiding any
possible adverse outcomes associated with the trial. The investigators also anticipate that
this study will provide objective guidelines on which patients will continue to improve after
nasogastric tube removal.
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