Upper Gastrointestinal Bleed — Considerations for Sump Placement and Gastric Lavage — Clinical Pathway: Emergency Department, ICU and Inpatient

Upper Gastrointestinal Bleed Clinical Pathway — Emergency Department, ICU and Inpatient

Considerations for Sump Placement and Gastric Lavage

Clinical utility remains unclear. Consider if:

  • Evidence of active bleeding:
    • Witnessed or persistent hematemesis
    • Worsening anemia
    • Lack of anticipated hemoglobin response post-transfusion
    • Persistent melena
  • Unclear location of bleeding

Additional considerations regarding sump placement may include estimated time of endoscopy, perceived rate of bleed, and provider preference for possible prophylactic gastric clearance prior to endoscopy.

Procedure Tips

Use Catheter Tip Syringe and Normal Saline at Room Temperature

Weight NS Volume for Lavage
< 10 kg 20 mL
≥ 10 kg 60 mL

Gastric Decompression with Sump

Consider intermittent suction as compared to continuous
Gastric Decompression via Naso/Orogastric Decompression Tube Procedure

Size Recommendations Based on Age for Nasogastric Placement
Age Approximate Weight Salem Sump Size
0-6 mos 3.5-7 kg 6 French
6 mos to 1 yr 10 kg 8 French
> 1 yr to < 3 yrs 12 kg 8 French
3 yrs to < 5 yrs 14 kg 8-10 French
5 yrs to < 6 yrs 18 kg 10 French
6 yrs to < 8 yrs 21 kg 10 French
8 yrs to < 12 yrs 27 Kg 10-12 French
12 yrs and older Varies 12, 14, 16, 18 French
Note: A larger tube is best for decompression

Size and Item #

Size Polyurethane Dual Sump Item #
6 French 86632
8 French 86633
10 French 86634
12 French 86635
14 French 86636
16 French 86637
18 French 87320

Reference

Randomized Pragmatic Trial of Nasogastric Tube Placement in Patients with Upper Gastrointestinal Tract Bleeding