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  • • Therapeutically: To remove gastric contents after poisoning or drug overdose.

    • Diagnostically: To confirm upper gastrointestinal bleeding.

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Absolute

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  • • Unstable airway.

    • Intestinal perforation.

    • Cervical spine trauma.

    • Facial trauma.

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Relative

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  • • Coagulopathy (prothrombin time > 18 seconds).

    • Thrombocytopenia (platelet count < 100,000/mcL).

    • Recent intestinal tract surgery (< 1 month ago).

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  • • Lubricant gel.

    • Large bore orogastric tube.

    • Terumo 60-mL catheter tip syringe.

    • Normal saline at 38 °C.

    • Drainage basin.

    • Stethoscope.

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  • • Perforation.

    • Bleeding.

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  • • Measure length of tube insertion by positioning the tube from the nares or mouth to the ear, and to the umbilicus.

    • There is also a standard table, which uses height of child.

    • If the tube is obstructed, flush first with water; longstanding obstruction may be removed by flushing the tube with caffeinated soda.

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  • • Explain indication and risks to the patient and parents.

    • Inform the patient of the intention of the procedure.

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  • • Left lateral head-down position with a 20-degree table tilt (Trendelenburg).

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  • • Tube position from the nose to the stomach.

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  • • Measure the length of insertion from the mouth to the ear to the epigastrium (Figure 26–1); mark it on the tube with an indelible pen.

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  • • Lubricate tube with gel.

    • Insert the tube through the mouth midline after lubrication.

    • Ask the patient to cooperate by swallowing while the tube is being inserted.

    • Advance the tube to the length mark.

    • To check position, aspirate tube with 50-mL catheter tip syringe (Figure 26–2); gastric aspirate confirms positioning in stomach.

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  • • Insert small amount of air (20–30 mL) via orogastric tube while listening to the epigastric area with stethoscope.

    • If unsure about tube position, obtain a chest film to confirm tube position.

    • Secure tube to the face with tape.

    • After insertion of the orogastric tube, begin to irrigate stomach with saline.

    • Use 10–15-mL/kg aliquots of warm (38 °C) isotonic saline.

    • Lavage should continue until the effluent is clear.

    • For diagnostic lavage, notice presence of fresh red blood, blood clots, or coffee ground material to confirm upper gastrointestinal bleeding.

    • • At this time, diagnostic lavage should be stopped.

      • Confirm presence of blood with Gastroccult cards.

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Figure 26–1.
Graphic Jump Location

Measuring the length of tube for insertion.

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Figure 26–2.
Graphic Jump Location

Checking the position of the tube.

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  • • Monitor intake and output volume.

    • Evaluate tube position.

    • Patient symptoms.

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  • • Aspiration.

    • Bleeding.

    • Perforation.

    • Mucosal tears.

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  • • There is no certain evidence that gastric lavage improves clinical outcome, and it can cause significant morbidity.

    • In experimental studies, ...

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