NonPneumatic

Antishock Garments
(NASG)
The NASG
 NASG
• It applies pressure to the legs and
abdomen.
• Blood returns to vital organs, Curbs
Internal bleed.
• Stabilizes BP until the patient reaches the
hospital.
• More than 1000 suits are in use.
• Application time- <60 seconds and easy.
 WHO STATISTICS
• Annually 1,50,000 women die of PPH
worldwide
• Out of which 99% die in developing
countries(1/61 developing countries Vs
1/2800 developed countries)

Unattended PPH can cause Death

within 2 hours
 How the NASG works
• First aid
• Controls bleeding through direct pressure
• Auto transfusion of blood in upward direction
• Ball in abdominal segment applies focused
pressure to Uterus
• Circumferential pressure on the lower half of
the body reducing the total vascular space
• Vital organs get increased blood supply and
oxygenation
• Stabilization of the patient during transport
How the NASG works
 About NASG………………
• The NASG is lightweight(1500g)
compression suit made of Neoprene.

• 5 segments enclosing Ankle, Thigh, Calves,

Pelvis and Abdomen.

• Velcro fastenings to keep garment tight.

• A small foam ball in the Abdominal section

applies pressure on the uterus to reduce
bleeding
 About NASG………………
• Correct and tight application supplies
20-40mm Hg circumferential pressure to
lower body, effective in reversing
hypovolemic shock

• Can be easily packed back into carry bag

 Application Of NASG
Step 1
• Place NASG under the woman with the
top at level of lowest rib
• Close segment 1 tightly around each
ankle
• Snap it and hear a sharp sound.

Step 2

• Close segment 2-Calf Muscle segment

• Leave the knee joint free
 Step 3
• Apply segment 3-Thigh segment

Step 4
• Apply segment 4-Pelvic segment
• All around the woman the lower edge at the
level of Pubic bone

Step 5
• Place segment 5 with pressure ball directly
over umbilicus
• Close the NASG using segment 6
• Only one person should close segments 4 and
5
• Should not be too tight to restrict breathing
 Step 6

• Ensure patient breathes normally after the

application.

• In case of uterine atony, administer

uterotonics and massage the uterus not
removing NASG as its flexible enough to allow
the massaging hand

• Ask the patient following:-

1)How are you feeling in the NASG?
2)Any breathing difficulties?
3)Any Discomfort?
4)Is it hot or itchy?
 Special Considerations
• In an unconscious patient:-

2 people are required to apply the garment

• In a short patient:-

Fold segment 1 inside segment 2,

beginning segment 2 at the ankle level and
segment 3 onwards as before
 NASG Removal
• Only under Medical supervision after
stabilizing vitals and checking hemoglobin
• IV fluids and Monitoring of vitals should be
continuous
• Step wise removal of NASG must be done
• NEVER open Abdominal segment first as it
causes rapid redistribution of blood and
patient might return to state of shock
• Can be done only in case of surgery is
planned that too in the OT in presence of
Anesthetist with readiness to handle abrupt
fall in BP
 NASG Removal
 Woman is stable for 2 hours
 Bleeding decreased to <50 ml/hr, Hb > 7g, Pulse <100
and Systolic BP 90-100 mm Hg
 Woman is conscious and aware
 Remove segment 1,Wait for 15 minutes

 Check Pulse and BP

 If Pulse rate increases by 20 or more and BP falls by
20mm Hg, reapply segment 1
 If vitals stable, remove segment 2

Follow same principle till removal of segment 6

Always wear gloves
 CAUTION: Rule of 20
If the blood pressure falls by 20 mm Hg or
the Pulse increases by 20 beats/min after a
segment is removed:-
1.Rapidly replace all segments and consider
the need for more saline or blood
transfusions
2.If there is recurrent bleeding, replace the
NASG and determine the source of bleeding
Avoiding adverse events when
using NASG
• One person alone should apply the body segments of
NASG

• Urine output should be monitored

• Ensure airway protection and prevent aspiration as

required

• Ensure one-on-one nursing care

• Ensure presence of a relative/support person with

unconscious patient, ready to explain the garment
when patient returns to consciousness
 Procedures with NASG
• Pelvic Examinations
• Vaginal Procedures can be performed with
NASG on:-
1)Repair of episiotomy or vaginal lacerations,
cervical lacerations
2)Manual removal of placenta
3)Bimanual compression
4)D&C,D&E
5)Manual vacuum aspiration
 Procedures with NASG
• Surgery
1. Laprotomy can be performed with the Pelvic
and Abdominal panel opened just prior to the
incision
2. Patient must be put in steep Trendelenberg
position
3. Operate quickly
4. Replace segments 4,5 and 6 after the procedure
Cleaning the NASG
 Folding the NASG
• Fold it correctly in such a way the
Velcro closure does not stick as you
unfold

• Incorrect folding causes time delay in

subsequent applications
 Fold Velcro of segment 1 to the inside of the segment

Fold Velcro of segment 2 to the inside of the segment

Fold Velcro of segment 3 to the inside of the segment

Fold leg segments together

Fold leg segments into abdominal segment

Fold segment 4 up across leg segments tucking the velcro at the ends
around to the inside

Fold segment 5 across leg segments

Wrap segment 6 tightly around segment 5

 Storing the NASG
• Put folded NASG in a clear plastic bag

• Store where the NASG is visible and easily accessible

• Always store at a same place, ensuring everyone knows

place of storage.

• Storage locations of all NASGs should be printed and

posted in a prominent place

• Replacement
It must be ensured that a facility that applies an NASG
on a woman in shock and refers her to a higher level gets
back a replacement NASG for future use.
 Relative Contraindications
• Heart failure
• Pre existing Mitral stenosis
• Pulmonary odema
• Advanced pregnancy with live fetus
• Abdominal evisceration
• Open fracture
 NASG-Discomforts
• Feeling hot-
Provide fan, AC

• Itching-
Relieve one leg at a time
Massage with lotion,
Do not open Abdominal segment

• Breathing difficulties-
Remove NASG and evaluate Cardio-
Respiratory status

• Fright of garment use-

Reassure
 NASG-Duration of use
• No particular time limit.

• Can be used until bleeding arrested

and volume restored-Even extending
into days(Recorded up to 58 hours)
 CONCLUSION
• First step in treating shock is-Apply the
NASG
• NASG reverses shock
• This gives time to do move her to a higher
level facility for treatment of shock
including blood transfusion and surgery
• When possible start IV crystalloid fluids at
lower level facilities if the cause of the shock
is uterine atony, use IV uterotonics
 CONCLUSION
• Start 2 IV lines-18G and give 1500 ml
crystalloids in the first hour
• Maintenance 150ml /hr
• Uterotonics
Syntocin/Methergine/Prostoglandins/
Misoprostal PR
• Vaginal procedures
Bi-manual compression/MRP/Curettage/
Laceration suture/Arterial ligation/
B lynch/Hysterectomy
THANK YOU!!!!!!!!!!!!!!!