• Coagulopathy (prothrombin time > 18 seconds).
• Thrombocytopenia (platelet count < 100,000/mcL).
• Recent intestinal tract surgery (< 1 month ago).
• Lubricant gel.
• Large bore orogastric tube.
• Terumo 60-mL catheter tip syringe.
• Normal saline at 38 °C.
• Drainage basin.
• 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
• Lubricate tube with gel.
• Insert the tube through the mouth midline after lubrication.
• Ask the patient to cooperate by swallowing while the tube is
• 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.
• Insert small amount of air (20–30 mL)
via orogastric tube while listening to the epigastric area with
• If unsure about tube position, obtain a chest film to confirm
• Secure tube to the face with tape.
• After insertion of the orogastric tube, begin to irrigate stomach
• 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
• At this time, diagnostic lavage should be stopped.
• Confirm presence of blood with Gastroccult cards.
Measuring the length of tube for insertion.
Checking the position of the tube.
• Mucosal tears.
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