How to Perform Gastric Lavage

It’s free cut and while her classmates went out to buy food, Chloe chose to stay at the library and do advanced reading. Her focus today is all about med-surg nursing and she is currently reading about the Nasogastric Tube. Upon scanning the book, she comes about gastric lavage. Hmm, sounds like gastric gavage, she thinks. But are they really the same? She finds herself asking as she reads more about the topic.

0001681_gdh80_transparent_gastric_lavage_simulatorHow to perform gastric lavage/ gastric suction/ stomach pumping

Usually, this procedure is done in emergencies, such as when someone has swallowed poison or overdosed on pills. However, other indications for this procedure include:

  • to collect a sample of stomach acid
  • to relieve pressure on blocked intestines
  • to suction out blood if a stomach hemorrhage occurs
  • to clean out your stomach if you are vomiting blood during an endoscopy, in which a scope is inserted down your esophagus.

Insertion

  • Before the procedure, the patient may be asked to take medicine to numb the throat, which will also help to decrease gagging or irritation.
  • A doctor will then insert a tube into the patient’s mouth or nose. The tube will go down through the esophagus (which is the pipe in the throat where food goes after swallowing) and will eventually enter the stomach.
  • The doctor may spray water or saline solution down the tube before applying suction to draw out the contents of the stomach. This saline solution can protect the patient against electrolyte imbalances that could occur due to the removal of fluids from the stomach.
  • The patient may feel like gagging while the tube is going in. Afterwards, the throat may feel irritated.
  • If the patient is having a tube inserted while recovering from abdominal surgery, it will stay in while he/she heals.
  • The tube will then be irrigated regularly with saline solution. The fluid helps to keep the tube open and prevent blockages. The amount of fluid needed will depend on the size of the tube and of the patient.

Performing the procedure

  • Before beginning gastric lavage, explain the procedure to the patient and obtain her verbal agreement to begin the procedure.
  • Test the patient’s gag reflex; immediately report an absent gag reflex as this may indicate the need for endotracheal intubation.
  • Gather the equipment and perform hand hygiene. Ensure that a suction device and a suction source are functional and within reach in case the patient vomits during the procedure.
  • Don gloves and measure the distance of the tubing from the tip of the nose to the ear lobe to the xiphoid process. Mark the distance on the tube with an indelible ink or with tape.
  • To set up the lavage equipment, connect one of the three pieces of large-lumen tubing to the irrigant container.
  •  Insert the stem of the Y connector into the other end of the tubing.
  • Connect the remaining two pieces of tubing to the free ends of the Y connector.
  •  Place the unattached end of one of the tubes into one of the drainage containers.
  •  Reserve the other piece of tubing for the patient’s gastric tube.
  • Clamp the tube leading to the irrigant and suspend the irrigant and the setup on the IV pole.
  • Drape a towel or a disposable pad over the patient’s chest to protect her clothing and linen and apply a topical anesthetic if prescribed. If the patient wears dentures, ask her to remove them.
  • In cases of poisoning or drug overdose, typically a large bore 36 to 40 French or 30 English-gauge orogastric tube (external diameter: 12 to 13.3 millimeters) is used for adults and a 24 to 28 French (external diameter: 7.8 to 9.3 millimeters) tube for children. A nasogastric tube is not wide enough to allow the aspiration of large particles such as medication tablets or capsules. When the lavage is indicated for diagnostic purposes or for gastrointestinal hemorrhage, a 16 to 20 French nasogastric tube may be used. If a nasogastric tube is to be inserted, inspect each naris for patency, noting any polyps, irritated mucosa, or other problems that might complicate insertion. Have the patient breathe through one naris at a time; select the more patent naris for insertion.
  • Place the patient in a head-down, left side-lying position to reduce the risk of aspiration if the patient vomits. Apply a water-soluble lubricant to the first 4 inches of the distal end of the tube. Insert the tube orally or nasally as indicated by the provider’s orders.
  • Ask the patient to swallow, then advance the tube until you have inserted the appropriate length of tubing.
  • Do not use force to pass the tube, especially if the patient is struggling. Inspect the back of the patient’s throat using a penlight and a tongue blade to ensure that the tube has not coiled.
  • Temporarily secure the oro- or nasogastric tube.
  • Ideally, proper tube placement is confirmed radiographically. If this is not possible, aspirate gastric contents and test the pH of the aspirate.
  • Once you have confirmed appropriate placement, secure the tube. If gastric samples are required for analysis, aspirate gastric contents and place the aspirate in a specimen container.
  • Connect the lavage tubing to the patient’s gastric tube.
  • Open the clamp to the irrigant solution and assess the patient’s vital signs, respiratory status, and level of consciousness. For an adult, use 200 to 300 mL, preferably of warm (100.4°F [38°C]) fluid, such as normal saline or water. For a child, use 10 mL/kg of warm normal saline (not water because of the risk of inducing hyponatremia and water intoxication in young children).
  • After the specified amount infuses, aspirate gastric contents by clamping the irrigant solution’s tubing and turning on the suction source.
  • Carefully monitor the volume instilled and the character and volume of aspirated contents. The volume of lavage fluid returned should approximate the amount of fluid given. Small volumes are used to minimize the risk of gastric contents entering the duodenum during lavage, since the amount of fluid affects the rate of gastric emptying. Warm fluids avoid the risk of hypothermia in the very young and very old and in those receiving large volumes of lavage fluid. Continue the lavage until the recovered lavage solution is clear of particulate matter, although a negative or poor lavage return does not rule out a significant ingestion or gastrointestinal hemorrhage.
  • Do not leave the patient alone during gastric lavage.
  • Monitor vital signs, respiratory status, and the patient’s level of consciousness continuously and report acute changes immediately to the provider.

Sources:

http://www.healthline.com/health/gastric-suction#Uses2http://www.atitesting.com/ati_next_gen/skillsmodules/content/nasogastric-intubation/equipment/performing.html

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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