spe10_gastric_082708

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SARASOTA MEMORIAL HOSPITAL

NURSING PROCEDURE

TITLE: GASTRIC LAVAGE

(spe10)

DATE:

REVIEWED:PAGES:

05/86

6/05, 8/081 of 5

ISSUED

FOR: Nursing

RESPONSIBILITY:

ECC—RN, Critical Care—RN

PURPOSE: To establish a procedure for gastric decontamination of

patients with known or suspected overdose.

KNOWLEDGE BASE: 1. Indications for gastric lavage in drug or toxiningestion include symptomatic patients who:

•

present within one hour of ingestion• have ingested a life-threatening amount of

drug or toxin that a sufficient dose ofactivated charcoal cannot be given toabolish the drug.

• Are hemodynamically unstable and presentwith an unknown substance and time ofingestion.

2. Contraindicated in patients who have ingestedstrong corrosives, sharp objects, or hydrocarbons. Alsocontraindicated in patients with known esophageal

varices.

3. This procedure should not be performed if the patientis unconscious, or in the absence of a gag reflexwithout prior intubation.

NOTE: Consult physician to obtain order forintubation. If ordered, consult Respiratory Therapyfor assistance.

Observe throughout procedure for changes in level

of consciousness and respiratory status. Should thepatient’s level of consciousness decrease at anytime during the procedure, immediately stop fluidinstillation and allow stomach to empty and notifyphysician.

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TITLE: GASTRIC LAVAGE(spe10)

PAGE: 2 of 5

EQUIPMENT: 1. Tum E Vac Kit contents:

a. 3500cc Irrigation Bagb. Tubing with universal connectorc. 5000cc Drainage Bag with Velcro strap

d. Piston syringee. Bite Blockf. 32 Fr. Lavage Tubeg. (2) 25 gram tubes of actidose with Sorbital

2. Activated charcoal (if not included)3. Protective equipment (gloves, goggles, gown)4. Oral airway5. Suction equipment (yankeur, etc.)

PATIENT EDUCATION: Explain the procedure to the patient.

PROCEDURE: 1. Assess respiratory status; ensure patent airway.Assess the cardiovascular and neurological status.

2. To facilitate passage of tube and prevent aspiration,patient should be positioned on left side, or semi-fowler position if they can’t be placed on left side. Ifpossible, a C-Spine should be cleared by physician.

3. Remove dentures and partial plates.

4. Apply protective equipment—gloves, gown, andgoggles.

5. If necessary, obtain time-limited physician order forrestraints. Restrain patient as indicated.

6. Have emesis basin and tissues readily available.

7. USE OF TUM-E-VAC GASTRIC LAVAGE SYSTEM:

a. Close all clamps on drainage and irrigationbags.

b. Fill irrigation bag with tap water or normalsaline and hang bag above patient on IV pole.

c. Position drainage bag below patient usingVelcro strap attached to bed rail.

d. Insert gastric lavage tube and check placementby inserting air through tube with piston syringe

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PAGE: 3 of 5

and auscultating for air bubbling in stomach.NOTE: Passage of the lavage tube may causevagal stimulation and precipitatebradydysrhythmmias.

e. Connect lavage tube firmly to connector after

cutting connector end for lavage tube size.f. Open clamp to irrigation bag allowing 300-

500ml fluid to drain into stomach.g. Close clamp to irrigation bag and open clamp

to drainage bag to drain fluid from stomach.h. When drainage is complete close clamp and

repeat step “f” and “g” until desired amount offluid is used or stomach is clear of gastriccontents.

8. METHODS OF ACTIVATED CHARCOALADMINISTRATIONS:

a. Add to irrigation bag:

1) Pour actidose into irrigation bag andallow to drain into stomach by gravity.(You may have to add some water tobag to facilitate charcoal drainage.)

2) Add 50-60ml water after charcoalinstilled to clear lavage tubing to insurefull dose of charcoal is received. Youmay do this using Piston syringe andpushing water through lavage tube.

b. Directly through gastric lavage tube:

1) Disconnect gastric lavage tube fromconnector.

2) Attach piston syringe, with plunger

removed to lavage tube.3) Pour actidose into syringe return

plunger and push into stomach.Repeat until full dose of charcoal isinstilled.

4) Follow charcoal dose with 50-60mlwater to clear tubing.

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PAGE: 4 of 5

c. By way of red connector port (this can only beused if charcoal is supplied in squeeze tube).

1) Cut tip on charcoal tube.2) Remove red cap from connector and

thread charcoal tube into connector.3) Slide twist lock key onto end of

charcoal tube and twist to expresscharcoal. (Too much pressure cancause the charcoal tube to pop offconnector port. Method “a” and “b”procedures are preferred.)

4) Instill 50-60ml water with piston syringeto clear tubing.

9. TROUBLE SHOOTING:

a. If fluid from irrigation bag does not drainproperly, there may be an obstruction in lavagetube. To clear tube, clamp irrigation tubing anddisconnect lavage tube from connector. Injectair through lavage tube using piston syringeand reconnect to connector.

b. Resume irrigation.

10. Remove gastric lavage tube quickly to avoid patientfrom gagging.

11. Offer mouthwash if patient is awake; forunconscious patients, assess oral cavity forsecretions and remove if present.

12. After procedure, position appropriately, e.g., headelevated or in side-lying position.

DOCUMENTATION: Nursing Reassessment Flowsheet/Nurses Notes:

Document procedure and patient response, gastriccontents as to color and pill fragments if any and amountof irrigation fluid instilled. Document any tests performedwith the gastric contents.

REFERENCES: Shollenberger, D., (2004) Nursing Procedures: FourthEdition. (pp 551-554). Lippincott Williams and Wilkins.Philadelphia: PA..

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PAGE: 5 of 5

McHale, D.J. and Carlson,K. AACN Procedure Manual. 4th Edition. (2001). (pp. 664-668). W.B. Saunders.Philadelphia: PA.

REVIEWING AUTHOR(S):

Lucille Sullivan, RN, Clinical Coordinator, ICUPaula Hopper, RN, BSN, Clinical Educator, ECC

APPROVAL: Nursing Standards and Practice, 8/7/08

spe10_gastric_082708

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