GASTRIC LAVAGE

Prepared by : Salwa Maghrabi Teacher Assistant Nursing Department

OUTLINES
Definition

of gastric lavage . Gastric lavage for gastrointestinal bleeding: Indications . Contraindications . The procedure . Complications.

CONT OUTLINES
Gastric

lavage for removal of toxic substance :

Indications Contraindications . Procedure . Complications .

OBJECTIVES
Define

gastric lavage . Enumerate the indications of gastric lavage . Mansion the contraindications and cautions of gastric lavage . Apply the procedure .

Definition of gastric lavage

Therapeutic procedure for washing out of the stomach with sterile water or normal saline .

Gastric lavage
1- Gastrointestinal Bleeding

Indications
Control acute upper GI hemorrhage Remove irritating gastric secretion Help evacuate clots Obtain information on the site and rate of bleeding

Contraindications and cautions

1.Knock the clot Shock Bleeding

2.Absent gag reflex .

3.Perforated viscus

Contraindications and Cautions Cont

4. Use of ice.

5. Confused , obtunded , sedated or

resisting the procedure patient

The Procedure

The equipment
Gastric tube
Irrigation tray

Adhesive tape Lubricating jelly

Cetacaine spry or xilocin spry

The Procedure Cont

The equipment cont

60 ml catheter tip syringe
Tincture of benzoin Normal saline or tap water

Bite block
Suction equipment

Irrigation try
Gastric tube

Adhesive tape

Lubricating jelly Cetacaine spry

60 ml syringe with catheter tip

Bite block Normal saline

Suction equipment

The Procedure Cont

Preparatory Phase
1 Protect the patient airway 2 Suction equipment available

3 Cardiac monitor and pulse oximetry

4 Insert large broe intravenous line 5 Insert gastric tube 6 Patient position

The Procedure Cont

Implementation Phase
1. Pour normal saline or tap water into an irrigation container 2. Draw up the solution 200to300 ml and installed to the stomach through gastric tube

3. Aspirate the solution

The Procedure Cont

Implementation Phase Cont

4. Repeat until Active bleeding stop .

5. Measuring and documenting .

1.Perforation of esophageal varices

2.MalloryWeiss tear

Complications

3.Aspirating of gastric content

4.Systemic hypothermia

Mallory-Weiss tear

esophageal varices

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Gastric Lavage
2- Removal of Toxic Substance

Used for removal of toxic substance or poisons from the stomach . Most effective if the procedure is completed within 60 min. of ingestion .

1- Ingest corrosive material or sharp objects. 3- Ingest substance that may cause seizures or abrupt central venous system depression. 4- Patient at risk for gastrointestinal bleeding or perforating secondary to pathology , recent surgery. 5- Not confirm the benefits of gastric lavage.

6- Increase the chance of drug absorption. 8- there is no end clear point for the procedure . 9- the traditional method of installing air while auscultating over the epigastrum to confirm the placement is not reliable.

The Equipment :
1- Cardiac

and pulse oximetry monitoring . 2- Orogastric tube : 36 to 40 Fr for adult . 24 to 32 Fr for children . 3- Lavage tubing setup. 4- Tubing clamp. 5- Activated charcoal

Pulse oximetry

Cardiac monitor

Activated charcoale

Preparation Phase:
1. 2. 3. 4. Restrain the patient. Obtain intravenous equipment . Assess the patient level of consciousness. Assemble the lavage tubing and prime it with fluid. 5. Insert a large orogastric tube .

Procedural steps

1- Aspirate the stomach content . 2- Unclamp the tubing between the fluid and the patient ,and instill 200- 300 ml of warmed fluid. 3- Unclamp the tubing between the patient and the drainage source and allow the fluid to drain into the bucket by use of gravity .

Cont Procedural steps

4- Repeat steps 1 and 2 until the fluid return is clear of stomach content. 5- if prescribed , instill activated charcoal .

1. 2. 3. 4. 5. 6. 7.

Tracheal placement of lavage tube . Aspiration Pneumonia . Hypoxia . Laryngospasm . Fluid and electrolyte imbalance . Vagal stimulation leading to bradycardia

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