Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression

Approval date: January 2023

Crumlin | Temple Street | Tallaght | Connolly

GUIDELINE ON THE INSERTION AND CARE OF A DUAL FLOW GASTRIC

DECOMPRESSION
Area of use: All of organisation ☒ CHI at Connolly ☐ CHI at Crumlin ☐
CHI at Herberton ☐ CHI at Tallaght ☐ CHI at Temple Street ☐
Lead author Michelle O’Gorman – CNEF
& title: Nicola Moss - CNEF
Approved by Karen McGuire
& title:
Version: Version 1 Approval date: January 2023
Qpulse reference: Revision due:
Version History
Version: Date approved: Summary of changes: Author:

Contents
1.0 Introduction ......................................................................................................................................................... 2
2.0 Definitions of Guidelines ...................................................................................................................................... 2
3.0 Applicable to ........................................................................................................................................................ 2
4.0 Objectives of the Guidelines ................................................................................................................................. 2
5.0 Definitions / Terms ............................................................................................................................................... 2
6.0 Guidelines .............................................................................................................. Error! Bookmark not defined.
7.0 Implementation Plan ............................................................................................................................................ 6
8.0 References ............................................................................................................................................................ 6
9.0 Appendices ............................................................................................................................................................ 7
Appendix 1 - Air Inlet

Appendix 2 - Closed Spigot

Appendix 3 - Where to record GI Losses and Replacement for Losses given

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Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

1.0 Introduction

A Dual Flow Gastric Tube is a radio-opaque double lumen tube used for gastric decompression for either conservative
or surgical management of a child presenting with an acute abdomen. It can used both to provide continuous low-
pressure suction, or intermittent drainage of gastric fluid and air.

2.0 Definition of Guidelines

Guidelines represent the written instructions about how to ensure high quality services are delivered. Guidelines
must be accurate, up to date, evidence-based, easy to understand, non-ambiguous and emphasise safety. When
followed they should lead to the required standards of performance

3.0 Applicable to

This guideline is applicable to the nursing care of a child presenting with an acute abdomen requiring gastric
decompression for either conservative or surgical management.

4.0 Objectives of the Guidelines

The purpose of this guideline is to promote safe, efficient and consistent practice in relation to the insertion and
management of a Dual Flow Gastric Tube.

5.0 Definitions / Terms

Dual Flow Gastric Tube

A Dual Flow Gastric Tube is a double lumen radio-opaque tube, which is inserted nasally into the stomach. The tube
consists of a wide bore drainage outlet and a smaller air inlet, which is left open to the air to maintain suction and
atmospheric pressure reducing adherence to the mucosal wall.

Continuous Low Pressure Suction

Continuous suction is where air, gastric and/or intestinal contents are withdrawn continuously with low pressure
allowing no time for them to accumulate.

Intermittent Drainage
This is where the wide bore drainage port is spigotted closed with a clear closed spigot, and then aspirated with a
syringe at regular interviews or as per instruction.

Free Drainage
This is where the wide bore port is attached to a drainage bag continuously allowing drainage of air and gastric
contents as needed without requiring suction. The air inlet is closed using a closed spigot.

Acute Abdomen
Sudden onset of abdominal pain requiring urgent evaluation, diagnosis and treatment.

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Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

6.0 Guidelines

Insertion of Dual Flow Gastric Tube

Equipment
 Plastic apron
 Disposable latex free gloves
 1 10ml syringe or 60ml syringe if aspiration is required
 pH paper (range 0-6)
 Lubricant
 Vygon Dual Flow Gastric Tube – appropriate size
 Skin protector Duoderm
 Tagerderm – to secure tube
 Emesis bowl, tissues

The size of a Dual Flow Gastric Tube should be determined by clinical assessment based on the size of the patient,
clinical need and in collaboration with the surgical team.

A pre medication maybe required in certain circumstances.

Placing of the Dual Flow Gastric Tube

ACTION RATIONALE & REFERENCE

Passing of a Dual Flow Gastric Tube may require 1-2
people during the procedure depending on the child.
Obtain verbal consent by explaining the procedure Appropriate explanations can help gain trust, co-operation
appropriately to the child and parent or carer. and reduce fears (Ball et al 2017)
Set out equipment, checking expiry dates and It is important to prepare your environment to ensure a
ensuring equipment is intact. smooth procedure (Trigg & Mohammed 2010)
Place on disposable apron and decontaminate hands
thoroughly. Throughout the Replogle placement,
please use Aseptic Non-Touch Technique level 3.
Open packages and cut tapes to size.
Position the child if able in a 45-degree angle or in the This will allow for easier swallowing to help facilitate
sitting position. The child may need to be held or passage of the tube. (Dougherty & Lister 2011)
supported.
Holding the child will prevent sudden movement ensuring
a safe insertion of the tube.
To measure the tube, place the tip of the tube at the
nostril and extend the tube to the bottom of their ear
lobe and then downward midway between the
xiphoid process and the umbilicus. Take note of the
number on the tube corresponding to the length
measurement.

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Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

Place a strip of duoderm to the cheek, which the Dual

Flow Gastric Tube will sit on once in place and
secured.
Lubricate the tube slightly prior to insertion and then Swallowing eases the passage of the tube and reduces the
steadily insert the tube up the nostril angling it risk of insertion into the trachea (Howe et al 2010)
slightly upwards to advance it along the base of the
nose into the pharynx and continue to glide the tube
until you get to the required measurement
(encourage swallowing using sips of water or via a
soother dependent on the age of the child). The tube
should now be in the stomach.

Check the child’s mouth to ensure the tube is not This will help to ensure correct positioning,
coiled in their throat.

TUBE PLACEMENT CONFIRMATION

One nurse will hold the tube in place while the 2nd nurse
confirms PH position.
Use a closed Spiggot in air inlet while checking aspirate.
DO NOT KNOT THE AIR INLET (see appendix 1 & 2)
Aspirate the Dual Flow Gastric Tube using a catheter tip 60 Aspiration of stomach contents indicates the
ml syringe by applying gentle negative pressure. pressure of the tube in the stomach (Clynes &
O’Connor 2010, NPSA 2011)
Test aspiration fluid with PH Paper and match colour A PH reading of 0-5.5 indicates contact with stomach
change of the strip with the colour code reference on the contents and verifies the tube position. (Bunford
box to identify the stomach content PH. 2010)
Once correct positon is determined, secure the tube onto
the child with adhesive tapes.
A skin protector or hydrocolloid dressing may be applied To Prevent skin reaction damage (Bunford 2010)
to the child’s cheek prior to securing the tube.
Remove closed spigot if tube is for Low Pressure Suction.
Dispose of equipment appropriately and document tube
insertion, depth of tube and side it is inserted,

Low Pressure Suction Set Up:

Equipment
 Low pressure suction regulator unit
 Suction tubing * 2
 Hourly receptacle measuring canister
 Standard suction canister
 Sims connector (if not with tubing package)
 Double suction point (to allow for both regular and low-pressure suction.)

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Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

Set up as picture below

NB: The Vygon Dual Flow Gastric Tube needs to be changed every 7 - 10 days as per manufactures guidelines.

Management and Care of a Dual Flow Gastric Tube on low pressure suction

 Ensure suction tubing and drainage canisters are below patient level to ensure effective drainage with gravity.
 Air inlet must be left open at all times while drainage port is connected to low pressure suction.
 Set the low suction pressure at the lowest KPA level required to provide adequate drainage- usually suction
needed would be between 5-10 KPA. This may need to be altered depending of contents consistency and
volume.
 Repogyle losses need to be measured and recorded hourly in the appropriate section on the IV fluid chart. This
is done by reading the level on the hourly drainage receptacle and then emptying this into the main suction
canister. Colour and consistency of output should be regularly monitored and documented appropriately in
nursing documentation.
 Repogyle Losses need to be replaced hourly and documented on the IV Fluid chart (unless otherwise instructed
by surgical team) using 0.9% NACL & 10mmol KCL in 500 mls. This is the standard replacement fluid used in CHI
at Crumlin. Losses are replaced ml/ml unless otherwise directed by surgical team. These replacement fluids
must be prescribed on the patient’s kardex.
 Patients require daily monitoring of Urea and Electrolyte bloods.
 An IV PPI should be prescribed while on low-pressure suction as per surgical team.

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Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

Troubleshooting

 If the air inlet leaks whilst the Dual Flow Gastric Tube is on low-pressure suction this usually indicates a blockage.
If this occurs, do not clamp the air inlet.
 Aspirate the main drainage port, check for a PH of less than 5.5 and then flush the drainage port with 5 mls of
sterile water.
 Re – attach to the low-pressure suction and check to see if leakage has stopped.
 If patient complains of feeling nauseous and / or vomiting, check tubing for kinks, ensure wall suction is working
and set up correctly, aspirate the drainage port to ensure it is not blocked. Suction level may need to be increased
to prevent further vomiting.

7.0 Implementation Plan

Guideline will be approved and placed on the hospital intranet and circulated via NPDU

8.0 References

Ball.J, Bindler.R, Cowen.K & Shaw.M (2017) Principles of Pediatric Nurising. 7th Edition. Pearson Education.

Bunford.C, (2010) Feeding 2. Enteral Feeding In Practices in childrens Nursing: Guidelines for community and Hospital.
3rd Edition. Trigg,E & Mohammed TA Eds), Churchill Livingstone, Eddinburgh, 388-400

Clynes. M & O’Connor. C (2010) Gastrointestinal System. In Clinical Skills in childrens Nurisng. (Coyne I, Neill. F, &
Timmons F Eds) Oxford University Press, Oxford 327-334

Dougherty L & Lister S (2020) The Royal Marsden Hospital Manual of Clinical Procedures. 10th Edition. Wiley Blackwell,
Oxford.

Howe.R, Forbes.D & Baker.C (2010) Providing optium nutrition and hydration in developing practical skills for nursing
children and young people. (Glasper A, Aylott.M, & Battrick.C Eds) Hodder Arnorld Publishers LTD, London 203-219.

OLCHC (2017) Aseptic Non-Touch Technique Quick Reference Guide. Dublin 12

Trigg.E, Mohammed.T (2010) Practices in Childrens Nursing. 3rd Edition. Churchill Livingstone

This is a controlled document. While this document may be printed the electronic version posted on Qpulse is the controlled copy and can
only be guaranteed for 24 hours after downloading.
Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

9.0 Appendices

Appendix 1 – Air Inlet Appendix 2 – Closed Spigot

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only be guaranteed for 24 hours after downloading.
Children’s Health Ireland Guideline On The Insertion And Care Of A Dual Flow Gastric Decompression
Approval date: January 2023

Appendix 3 - Where to record GI Losses and Replacement for Losses given

GI Losses Replacement for

recorded here losses given
please recorded here
please

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