GASTRIC LAVAGE
Prepared by : Salwa Maghrabi Teacher Assistant Nursing Department
OUTLINES
Definition
of gastric lavage . Gastric lavage for gastrointestinal bleeding: Indications . Contraindications . The procedure . Complications.
CONT OUTLINES
Gastric
lavage for removal of toxic substance :
Indications Contraindications . Procedure . Complications .
OBJECTIVES
Define
gastric lavage . Enumerate the indications of gastric lavage . Mansion the contraindications and cautions of gastric lavage . Apply the procedure .
Definition of gastric lavage
Therapeutic procedure for washing out of the stomach with sterile water or normal saline .
Gastric lavage
1- Gastrointestinal Bleeding
Indications
Control acute upper GI hemorrhage Remove irritating gastric secretion Help evacuate clots Obtain information on the site and rate of bleeding
Contraindications and cautions
1.Knock the clot Shock Bleeding
2.Absent gag reflex .
3.Perforated viscus
Contraindications and Cautions Cont
4. Use of ice.
5. Confused , obtunded , sedated or
resisting the procedure patient
The Procedure
The equipment
Gastric tube
Irrigation tray
Adhesive tape Lubricating jelly
Cetacaine spry or xilocin spry
The Procedure Cont
The equipment cont
60 ml catheter tip syringe
Tincture of benzoin Normal saline or tap water
Bite block
Suction equipment
Irrigation try
Gastric tube
Adhesive tape
Lubricating jelly Cetacaine spry
60 ml syringe with catheter tip
Bite block Normal saline
Suction equipment
The Procedure Cont
Preparatory Phase
1 Protect the patient airway 2 Suction equipment available
3 Cardiac monitor and pulse oximetry
4 Insert large broe intravenous line 5 Insert gastric tube 6 Patient position
The Procedure Cont
Implementation Phase
1. Pour normal saline or tap water into an irrigation container 2. Draw up the solution 200to300 ml and installed to the stomach through gastric tube
3. Aspirate the solution
The Procedure Cont
Implementation Phase Cont
4. Repeat until Active bleeding stop .
5. Measuring and documenting .
1.Perforation of esophageal varices
2.MalloryWeiss tear
Complications
3.Aspirating of gastric content
4.Systemic hypothermia
Mallory-Weiss tear
esophageal varices
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Gastric Lavage
2- Removal of Toxic Substance
Used for removal of toxic substance or poisons from the stomach . Most effective if the procedure is completed within 60 min. of ingestion .
1- Ingest corrosive material or sharp objects. 3- Ingest substance that may cause seizures or abrupt central venous system depression. 4- Patient at risk for gastrointestinal bleeding or perforating secondary to pathology , recent surgery. 5- Not confirm the benefits of gastric lavage.
6- Increase the chance of drug absorption. 8- there is no end clear point for the procedure . 9- the traditional method of installing air while auscultating over the epigastrum to confirm the placement is not reliable.
The Equipment :
1- Cardiac
and pulse oximetry monitoring . 2- Orogastric tube : 36 to 40 Fr for adult . 24 to 32 Fr for children . 3- Lavage tubing setup. 4- Tubing clamp. 5- Activated charcoal
Pulse oximetry
Cardiac monitor
Activated charcoale
Preparation Phase:
1. 2. 3. 4. Restrain the patient. Obtain intravenous equipment . Assess the patient level of consciousness. Assemble the lavage tubing and prime it with fluid. 5. Insert a large orogastric tube .
Procedural steps
1- Aspirate the stomach content . 2- Unclamp the tubing between the fluid and the patient ,and instill 200- 300 ml of warmed fluid. 3- Unclamp the tubing between the patient and the drainage source and allow the fluid to drain into the bucket by use of gravity .
Cont Procedural steps
4- Repeat steps 1 and 2 until the fluid return is clear of stomach content. 5- if prescribed , instill activated charcoal .
1. 2. 3. 4. 5. 6. 7.
Tracheal placement of lavage tube . Aspiration Pneumonia . Hypoxia . Laryngospasm . Fluid and electrolyte imbalance . Vagal stimulation leading to bradycardia
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