Gastric lavage – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Gastric lavage
Definition of Gastric Lavage:
Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach.
Or,
Gastric lavage is a gastrointestinal decontamination technique that aims to empty the stomach of toxic substances by the sequential administration and aspiration of small volumes of fluid via an orogastric tube.
Purposes of Gastric lavage:
- Remove unabsorbed poison after ingestion.
- Diagnosis and stop gastric haemorrhage.
- Clean stomach before diagnostic procedures.
- Remove liquid or small particles of material from stomach.
- To relieve nausea and vomiting in case of acute dilatation of stomach, pyloric stenosis and intestinal obstruction.
- To cleanse the stomach as a preparation for surgery.
- To obtain casts of epithelial cells for bacteriological studies.
Indications of Gastric lavage:
- Gastric lavage is used infrequently in modern poisoning treatment. Some authorities have actually suggested that it not be used routinely, if ever, in poisoning situations.
- Lavage should only be considered if the amount of poison ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion.
- Lavage is also the initial treatment for duodenal atresia in newborns, a condition where the small intestine is closed distal to the stomach, causing food and fluid to accumulate in the stomach.
- When the body temperature rises above 40 °C, gastric lavage with iced saline also can be an aggressive cooling measure in a medical emergency.
Contraindications of Gastric lavage
- If initial resuscitation incomplete
- Risk assessment indicates good outcome with supportive care and antidote therapy alone
- Unprotected airway where there is a decreased level of consciousness or risk assessment indicates potential for these complications during the procedure
- Small children
- Corrosive ingestion
- Hydrocarbon ingestion
Procedure! Technique:
Requirement
- Nasogastric insertion equipment’s.
- Lavage fluid-Nacl or other prescribed solution.
- Syringe 20ml for aspiration and 50ml for lavage.
- Specimen container with lab request form.
- Kidney dish as receiver.
- Measuring jug
- Protective sheet.
- Clinical waste.
- Domestic waste.
Steps
1. Verify Doctors order.
2. Asses patient level of consciousness.
3. Greet patient and explain procedure.
4. Provide privacy.
5. Remove dental appliances and inspect oral cavity for loose teeth.
6. Position patient in Semi-Fowler’s.
7. Insert NG tube as per procedure handout.
8. Check placement of tube in stomach (3 times check).
9. Aspirate stomach contents before instilling water or antidote. Keep specimen in container for analysis.
10. Remove 20ml syringe and attach with 50ml syringe to pour lavage solution into NG tube or attach with 50ml syringe barrel.
11. Pour or inject slowly 20ml solution and wait for 1 minute.
12. Aspirate (if use syringe) or siphon (if use barrel) gastric content sand discard it in kidney dish.
13. Save samples of first two washings.
14. Record input and output throughout procedures.
15. Repeat step 10-14 until returns are clear. Usually requires a total volume of 2 liters.
16. Remove NG tube as per procedure handout.
17. Make patient comfortable.
18. Label specimens and dispatch to lab immediately.
19. Clean and clear equipments.
20. Record and report findings
Nursing Responsibilities
1. Ensure procedure is carried out on correct client at correct site.
2. Assess patient’s level of consciousness.
3. Ensure patient’s comfort is maintained throughout procedure-Fowler’s position.
4. Perform procedure in a correct manner. Use appropriate solution.
5. Monitor vital sign for pre, intra and post procedure.
6. Monitor input and output.
7. Send labeled specimens in appropriate container with lab request form.
8. Record and report findings.
Complications of Gastric lavage:
- Incomplete decontamination leading to severe intoxication despite the procedure
- Pulmonary aspiration
- Hypoxia
- Laryngospasm
- Mechanical injury to the gastrointestinal tract
- Water intoxication (especially in children)
- Hypothermia
- Distraction of staff from resuscitation and supportive care priorities
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