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REMOVING A TUBE. As a general rule, leave a tube in place until: (1) There are normal bowel sounds. (2) There is no abdominal distension. (3) His bowel has moved normally or he has passed flatus. (4) There are only about 400 ml of gastric aspirate daily. This is the normal volume; if you aspirate 750 ml or more, suspect ileus or gut obstruction. If his stomach has a suture line in it, remove the tube at 4 to 5 days. If you are in doubt as to when to remove a tube, clamp it for 24 hours, and if nausea and distension do not return remove it. CAUTION ! Don't remove a patient's nasogastric tube if he is nauseated, or distended, or he has passed no flatus, or has more than 500 ml of gastric aspirate. If he has any of these, he probably has paralytic ileus or obstruction, or peritonitis, or an anastomosis that is too narrow.

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