AIIMS Delhi NO- 2019: Which of the following is the contraindication of gastric aspiration from NG tube?

AIIMS Delhi NO- 2019

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Delhi NO- 2019

Explanation

Esophageal varices are abnormally dilated and fragile veins located in the submucosa of the lower esophagus.
They are most often a complication of portal hypertension, commonly seen in patients with advanced liver disease (cirrhosis).
The negative pressure from suction during gastric aspiration can cause these delicate varices to rupture.
Rupture of esophageal varices leads to massive, life-threatening gastrointestinal hemorrhage, which is a medical emergency.

Option A: Hypertension (high blood pressure) is a cardiovascular condition and not a direct contraindication for gastric aspiration. While uncontrolled hypertension poses risks for many procedures, it does not specifically prevent the safe performance of NG tube aspiration.
Option B: Diabetes is a metabolic disorder affecting blood sugar control. It does not have a direct bearing on the structural integrity of the esophagus or stomach in a way that would contraindicate gastric aspiration.
Option D: Severe dehydration is a state of significant fluid loss. It is a condition to be treated, often with fluid resuscitation, which can sometimes be administered via an NG tube. It is not a reason to avoid gastric aspiration.

Clinical Relevance

Nursing practice connection: Knowing Contraindications for Nasogastric (NG) Tube Procedures helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse must always review a patient's history for conditions like liver disease or known esophageal varices before attempting any NG tube procedure. This is a critical patient safety check.
If a patient with a known history of liver cirrhosis and an NG tube suddenly develops hematemesis (vomiting blood) or melena (black, tarry stools), the nurse must immediately stop any suction, notify the physician, and prepare for an emergency response for variceal bleeding.
What if the patient has a history of alcoholism but no confirmed diagnosis of varices? The nurse should proceed with extreme caution, use the gentlest technique possible for insertion and aspiration, and closely monitor for any signs of bleeding, as chronic alcohol use is the leading cause of cirrhosis and subsequent varices.

How to Approach the Question

First, identify the core of the question: it asks for a contraindication to a specific procedure (gastric aspiration via NG tube).
A 'contraindication' is a condition or factor that serves as a reason to withhold a certain medical treatment due to the harm that it would cause the patient.
Evaluate each option by considering its pathophysiology and how it might interact with the procedure.
Option A (Hypertension) and B (Diabetes) are systemic diseases but don't create a direct mechanical risk in the esophagus.
Option D (Severe dehydration) is about fluid balance, not esophageal structure.
Option C (Esophageal varices) refers to fragile, swollen veins in the esophagus. Consider the mechanical action of suction. Suction creates negative pressure, which could easily rupture these fragile vessels, leading to severe bleeding. This presents a direct and life-threatening risk, making it a clear contraindication.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 761-763

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 52-54