Question

What is the rationale for a provider to order NGT insertion, NPO status, large bore IVs, CBC, Type and screen and EGD on a patient with GI bleed?

Answer 1

1. NGT- Nasogastric (NG) lavage by NGT is an intuitively logical procedure for evaluation of the patient suspected of having acute upper GI bleeding. Indeed, a bloody NG aspirate is a good predictor of finding a high-risk lesion on upper endoscopy.

2. NPO- While performing an initial assessment the patient should be kept NPO (nil per os) in order to decrease the risk of further aggravating the bleeding and in anticipation of diagnostic tests or endoscopy that will require sedation, and have intravenous (IV) access obtained.

3. Large bore IV- Depending on the amount of blood loss fluids is given through a large bore needle (IV) and, possibly, blood transfusions.

4. CBC- complete blood count, a test to see how fast your blood clots, a platelet count and liver function tests.

5. Type of GI bleeding
a. upper GI bleeding
b. lower GI bleeding

6. Screen of GI- upper GI endoscopy and colonoscopy to test for acute GI bleeding in the upper and lower GI tracts.

7. EGD- An esophagogastroduodenoscopy (EGD) is performed if a nasogastric (NG) tube aspirate is positive for blood, because about 10% of patients presenting with lower gastrointestinal bleeding (LGIB) have bleeding originating from the upper GI tract