Gastric

Lavage
Overview
● Gastric lavage is a gastrointestinal decontamination
technique that aims to empty the stomach of toxic
substances by the sequential administration and
aspiration of small volumes of fluid via an orogastric
tube.
Overview
● Gastric lavage is the washing out of the stomach via a
nasogastric tube or stomach tube. Lavage is ordered to wash
out the stomach (after ingestion of poison or an overdose of
medication, for example) or to control gastrointestinal
bleeding. If the patient does not have a nasogastric tube in
place already, the physician will order the insertion of the
appropriate tube.
Purpose of Gastric Lavage
● For ugent removal of ingested substance to decrease
systemic absorption.
● To empty the stomach before endoscopy procedure
● To diagnose and to arrest gastric hemorrhage
● To relieve nausea and vomiting in case of acute dilation of
stomach pyloric stenosis and intestinal obstruction.
Gastric Lavage
● For a stomach wash, the physician will probably order the insertion of an
Ewald stomach tube or a large lumen nasogastric tube. To control
gastrointestinal bleeding, a large lumen Levine tube or Salem sump tube
will be inserted. In the event of severe bleeding, as in the case of
esophageal varices, a Sengstaken-Blakemore tube will be inserted. A
large lumen tube is preferred, since particles of food or other material
may occlude the lumen of a small tube. The tube must be checked to
verify proper placement in the stomach prior to proceeding with lavage.
Equipment
● Syringes, 2 or more, 50cc catheter tip.
● Washbasins, 2 (to collect used solution).
● Bath towels.
● Chux pads.
● Emesis basin.
● Paper tissues.
● Graduated container for measuring.
● Prescribed lavage solution (usually, normal saline solution).
● Suction equipment readily available.
● Water Soluble lubcricant
● Gloves
Contraindication
● Initial resuscitation incomplete
● Risk assessment indicates good outcome with supportive care and
antidote therapy alone
● Unprotected airway where there is a decreased level of consciousness or
risk assessment indicates potential for these complications during the
procedure
● Small children
● Corrosive ingestion
● Hydrocarbon ingestion
Procedure
● Remove dentures and insepct the oral cavities for loose teeth to prevent
aspiration of teeth.
● Measure the distance between the bridge of the nose and xiphoid process
and mark it because the tube must be enough to reach the stomach and
avoid excess tubing that may curl and kink in the stomach
● Lubricate the tube with water soluble lubricant.
● If the patient is unconscious, intubate with cuffed endotracheal tube
before placement of the nasogastric tube to prevent aspiration.
Procedure
● Pass the tube either orally or through the nose upto the marked distance.
● Place the patient in left lateral position with lowered about 15 degree. It
will allow the gastric contents to pull and decrease the passage of fluid
into the duodenum during Lavage.
● Aspirate the stomach contents with synringe before installing water or
antidote and save the specimen for analysis, ensure correct placement of
the tube before installation.
● Remove syringe and attach the funnel to end of the tube.
● Elevate the funnel above the patients head and pour the fluid into the
funnel, about 250 to 500 ml fluid is to be introduced to reach all parts of
the mucous membranes of the stomach.
Procedure
● Lower the funnel and siphon the gastric contents into the container or
connect to suction.
● Save sample for the first two washing.
● Repeat the lavage procedure until the returns are relatively clear and no
particulate matter is seen.
● At the completion of lavage, the stomach may be left empty if no
further medications are required
● An absorbent may be instilled in the tube and allowed to remain in the
stomach because it reduces absorption of substance and renders the
poison inaccessible to the circulation
● A saline cathartic may be installed in the tube to hasten the elimination
of remaining ingested material.
Procedure
● Pinch off or clamp the tube and withdraw it quickly. Keep the patient’s
head lower than the body to prevent initiation of gag reflex.
● Give a mouthwash and dry the face.
● Record the procedure with time and date type,and amount of solution
used, the character of return flow, the condition of the patient before
during and after the procedure on nurses record.