Skip to Main Content

+

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

    • Diagnostically: To confirm upper gastrointestinal bleeding.

++

Absolute

+

  • • Unstable airway.

    • Intestinal perforation.

    • Cervical spine trauma.

    • Facial trauma.

++

Relative

+

  • • 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.

    • Stethoscope.

+

  • • Perforation.

    • Bleeding.

+

  • • 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.

+

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

    • Inform the patient of the intention of the procedure.

+

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

+

  • • Tube position from the nose to the stomach.

+

  • • 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.

+

  • • 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.

+

  • • 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.

++
Figure 26–1.
Graphic Jump Location

Measuring the length of tube for insertion.

++
Figure 26–2.
Graphic Jump Location

Checking the position of the tube.

+

  • • Monitor intake and output volume.

    • Evaluate tube position.

    • Patient symptoms.

+

  • • Aspiration.

    • Bleeding.

    • Perforation.

    • Mucosal tears.

+

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

    • In ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.