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Gastric lavage Reporter :Abalo ,Jay Mar O.

Gastrict lavage

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Page 1: Gastrict lavage

Gastric lavage

Reporter :Abalo ,Jay Mar O.

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It is commonly called stomach pumping or gastric irrigation, it is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a poison or overdosed on a drugs.

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Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract. It may play a role in the evaluation of hematemesis. It can also be used as a cooling technique for hyperthermic patients.

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To remove gastric contents when emesis induction is unproductive or contraindicated.


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• To emphasize the function of gastric lavage.

• To determine the conditions that contraindicate the use of lavage

• To empart to the listener the right way to perform lavage

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When it is important to remove or dilute gastric contents rapidly, gastric lavage, irrigation or washing out of the stomach, may be indicated. In acute poisoning or ingestion of a caustic substance, a large bore 30- to 36- French nasogastric tube is inserted, and lavage performed. When gastric hemorrhage occurs, lavage may be used to remove blood from the GI tract. Because the GI tract is not sterile, clean technique is appropriate for use, although the solution used will generally be sterile.

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Things to remember before doing gastrict lavage

A corrosive agent is present, where esophagus or gastric perforation can occur with orogastric tube placement (e.g., drain cleaners, oven cleaners, ultra bleach, batteries)

Petroleum distillates or hydrocarbons (e.g., gasoline, kerosene, motor oil) are involved, which may be easily aspirated on account of low viscosity

Sharp objects were ingested (e.g., sewing needles) Patients with craniofacial abnormalities, Concomitant head trauma, or a number of other bodily injuries may not tolerate the lavage

procedure. Gastric lavage is contraindicated if the patient has an unprotected airway, such as in a

patient with a depressed level of consciousness without endotracheal intubation. Gastric lavage is also contraindicated if its use increases the risk and severity of aspiration

(such as a patient who has ingested a hydrocarbon with high aspiration potential)

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Patients who are at risk of hemorrhage or gastrointestinal perforation due to pathology, recent surgery or other medical condition, could be further compromised by the use of gastric lavage.

If a patient refuses to cooperate and resists, it should be considered at least as a relative contraindication for performing gastric lavage because complications maybe more likely.

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Procedure and guidelinesHow to perform gastric lavage/ gastric suction/ stomach pumping

Usually, this procedure is done in emergencies, such as when someone has swallowed poison or overdosed on pills. However, other indications for this procedure include: to collect a sample of stomach acid to relieve pressure on blocked intestines to suction out blood if a stomach hemorrhage occurs to clean out your stomach if you are vomiting blood during an endoscopy, in which

a scope is inserted down your esophagus.

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1. Explain the procedure, answering questions and clarifying perceptions. Instruct to report any pain, difficult breathing, or other problems during the procedure. A client who is able to understand and cooperate with the procedure will tolerate lavage better. The client may be aware of symptom of complications such as perforation or tube displacement before they are evident to the nurse

2. Obtain baseline assessment, including vital signs, abdominal inspection, girth, and bowel sounds. It is important to have assessment data documented prior to instituting the procedure for comparison.

3. Test the patient’s gag reflex; immediately report an absent gag reflex as this may indicate.

4. Gather the equipment and perform hand hygiene. Ensure that a suction device and a suction source are functional and within reach in case the patient vomits during the procedure.

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In cases of poisoning or drug overdose, typically a large bore 36 to 40 French or 30 English-gauge orogastric tube (external diameter: 12 to 13.3 millimeters) is used for adults and a 24 to 28 French (external diameter: 7.8 to 9.3 millimeters) tube for children. A nasogastric tube is not wide enough to allow the aspiration of large particles such as medication tablets or capsules. When the lavage is indicated for diagnostic purposes or for gastrointestinal hemorrhage, a 16 to 20 French nasogastric tube may be used. If a nasogastric tube is to be inserted, inspect each naris for patency, noting any polyps, irritated mucosa, or other problems that might complicate insertion. Have the patient breathe through one naris at a time; select the more patent naris for insertion.

5.Place in semi-Fowler’s or Fowler’s position. If unable to tolerate elevation of the head of the bed because of hypotension, place in left side-lying position. Elevating of the head of the bed or side-lying position will minimize the risk of aspiration.

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6.Drape a towel or a disposable pad over the patient’s chest to protect her clothing and linen and apply a topical anesthetic if prescribed. If the patient wears dentures, ask her to remove them

7.Don gloves and measure the distance of the tubing from the tip of the nose to the ear lobe to the xiphoid process. Mark the distance on the tube with an indelible ink or with tape.

8.Apply a water-soluble lubricant to the first 4 inches of the distal end of the tube.

9.A doctor will then insert a tube into the patient’s mouth or nose. The tube will go down through the esophagus (which is the pipe in the throat where food goes after swallowing) and will eventually enter the stomach.

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10.To set up the lavage equipment connect one of the three pieces of large-lumen tubing to the irrigant container.  Insert the stem of the Y connector into the other end of the tubing. Connect the remaining two pieces of tubing to the free ends of the Y connector.  Place the unattached end of one of the tubes into one of the drainage containers.  Reserve the other piece of tubing for the patient’s gastric tube. Clamp the tube leading to the irrigant and suspend the irrigant and the setup on the IV pole.

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11.Ask the patient to swallow, then advance the tube until you have inserted the appropriate length of tubing.

12.Do not use force to pass the tube, especially if the patient is struggling. Inspect the back of the patient’s throat using a penlight and a tongue blade to ensure that the tube has not coiled.

13.Temporarily secure the oro- or nasogastric tube.

14.Connect the lavage tubing to the patient’s gastric tube.

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15.Verify tube placement by auscultating the abdominal area with the use of stethoscope, if it is placed in the stomach it normally has a gurgling sound upon flushing of air with the use of asepto syringe ,or aspirate gastric contents and test pH gastrict content. Proper placement is vital to prevent aspiration or over distention of the small bowel with irrigating solution.16.The doctor may spray water or saline solution down the tube before applying suction to draw out the contents of the stomach. This saline solution can protect the patient against electrolyte imbalances that could occur due to the removal of fluids from the stomach.17The patient may feel like gagging while the tube is going in. Afterwards, the throat may feel irritated.

18.The tube will then be irrigated regularly with saline solution. The fluid helps to keep the tube open and prevent blockages. The amount of fluid needed will depend on the size of the tube and of the patient.

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19.Open the clamp to the irrigant solution and assess the patient’s vital signs, respiratory status, and level of consciousness. For an adult, use 200 to 300 mL, preferably of warm (100.4°F [38°C]) fluid, such as normal saline or water. For a child, use 10 mL/kg of warm normal saline (not water because of the risk of inducing hyponatremia and water intoxication in young children).

20.After the specified amount infuses, aspirate gastric contents by clamping the irrigant solution’s tubing and turning on the suction source.21.Carefully monitor the volume instilled and the character and volume of aspirated contents. The volume of lavage fluid returned should approximate the amount of fluid given. Small volumes are used to minimize the risk of gastric contents entering the duodenum during lavage, since the amount of fluid affects the rate of gastric emptying.Warm fluids avoid the risk of hypothermia in the very young and very old and in those receiving large volumes of lavage fluid. Continue the lavage until the recovered lavage solution is clear of particulate matter, although a negative or poor lavage return does not rule out a significant ingestion or gastrointestinal hemorrhage.

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22.Do not leave the patient alone during gastric lavage.

23.Monitor vital signs, respiratory status, and the patient’s level of consciousness continuously and report acute changes immediately to the provider.

24. Perform after care.

25.Perform hand washing

26.Record all the things you’ve done, the time of procedure started until the time it ended, assessment before and after the procedure, amount of fluid color odor of gastric contents, and the collected specimen in the nurses’ notes.

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Benson, B., K. Hoppu, K. et al.(2013). Position paper update: gastric lavage for gastrointestinal

decontamination. Clinical Toxicology. Informa Healthcare USA, Inc, 140 –146.