Chapter 26. Gastric Lavage

• • 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.

• • 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.

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