SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE TITLE: GASTRIC LAVAGE (spe10) DATE: 05/86 REVIEWED: 6/05, 8/08 PAGES:

1 of 5 RESPONSIBILITY: Nursing ECCRN, Critical CareRN To establish a procedure for gastric decontamination of patients with known or suspected overdose. 1. Indications for gastric lavage in drug or toxin ingestion include symptomatic patients who: present within one hour of ingestion have ingested a life-threatening amount of drug or toxin that a sufficient dose of activated charcoal cannot be given to abolish the drug. Are hemodynamically unstable and present with an unknown substance and time of ingestion. 2. Contraindicated in patients who have ingested strong corrosives, sharp objects, or hydrocarbons. Also contraindicated in patients with known esophageal varices. 3. This procedure should not be performed if the patient is unconscious, or in the absence of a gag reflex without prior intubation. NOTE: Consult physician to obtain order for intubation. If ordered, consult Respiratory Therapy for assistance. Observe throughout procedure for changes in level of consciousness and respiratory status. Should the patients level of consciousness decrease at any time during the procedure, immediately stop fluid instillation and allow stomach to empty and notify physician.

ISSUED FOR: PURPOSE:

KNOWLEDGE BASE:

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GASTRIC LAVAGE (spe10) 1. Tum E Vac Kit contents: a. b. c. d. e. f. g. 2. 3. 4. 5.

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EQUIPMENT:

3500cc Irrigation Bag Tubing with universal connector 5000cc Drainage Bag with Velcro strap Piston syringe Bite Block 32 Fr. Lavage Tube (2) 25 gram tubes of actidose with Sorbital

Activated charcoal (if not included) Protective equipment (gloves, goggles, gown) Oral airway Suction equipment (yankeur, etc.)

PATIENT EDUCATION: PROCEDURE:

Explain the procedure to the patient. 1. Assess respiratory status; ensure patent airway. Assess the cardiovascular and neurological status. To facilitate passage of tube and prevent aspiration, patient should be positioned on left side, or semifowler position if they cant be placed on left side. If possible, a C-Spine should be cleared by physician. Remove dentures and partial plates. Apply protective equipmentgloves, gown, and goggles. If necessary, obtain time-limited physician order for restraints. Restrain patient as indicated. Have emesis basin and tissues readily available. USE OF TUM-E-VAC GASTRIC LAVAGE SYSTEM: a. b. c. d. Close all clamps on drainage and irrigation bags. Fill irrigation bag with tap water or normal saline and hang bag above patient on IV pole. Position drainage bag below patient using Velcro strap attached to bed rail. Insert gastric lavage tube and check placement by inserting air through tube with piston syringe

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3. 4.

5.

6. 7.

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GASTRIC LAVAGE (spe10)

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e. f. g. h.

and auscultating for air bubbling in stomach. NOTE: Passage of the lavage tube may cause vagal stimulation and precipitate bradydysrhythmmias. Connect lavage tube firmly to connector after cutting connector end for lavage tube size. Open clamp to irrigation bag allowing 300500ml fluid to drain into stomach. Close clamp to irrigation bag and open clamp to drainage bag to drain fluid from stomach. When drainage is complete close clamp and repeat step f and g until desired amount of fluid is used or stomach is clear of gastric contents.

8.

METHODS OF ACTIVATED CHARCOAL ADMINISTRATIONS: a. Add to irrigation bag: 1) Pour actidose into irrigation bag and allow to drain into stomach by gravity. (You may have to add some water to bag to facilitate charcoal drainage.) Add 50-60ml water after charcoal instilled to clear lavage tubing to insure full dose of charcoal is received. You may do this using Piston syringe and pushing water through lavage tube.

2)

b.

Directly through gastric lavage tube: 1) 2) 3) Disconnect gastric lavage tube from connector. Attach piston syringe, with plunger removed to lavage tube. Pour actidose into syringe return plunger and push into stomach. Repeat until full dose of charcoal is instilled. Follow charcoal dose with 50-60ml water to clear tubing.

4)

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GASTRIC LAVAGE (spe10) c.

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By way of red connector port (this can only be used if charcoal is supplied in squeeze tube). 1) 2) 3) Cut tip on charcoal tube. Remove red cap from connector and thread charcoal tube into connector. Slide twist lock key onto end of charcoal tube and twist to express charcoal. (Too much pressure can cause the charcoal tube to pop off connector port. Method a and b procedures are preferred.) Instill 50-60ml water with piston syringe to clear tubing.

4)

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TROUBLE SHOOTING: a. If fluid from irrigation bag does not drain properly, there may be an obstruction in lavage tube. To clear tube, clamp irrigation tubing and disconnect lavage tube from connector. Inject air through lavage tube using piston syringe and reconnect to connector. Resume irrigation.

b.

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Remove gastric lavage tube quickly to avoid patient from gagging. Offer mouthwash if patient is awake; for unconscious patients, assess oral cavity for secretions and remove if present. After procedure, position appropriately, e.g., head elevated or in side-lying position.

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DOCUMENTATION:

Nursing Reassessment Flowsheet/Nurses Notes: Document procedure and patient response, gastric contents as to color and pill fragments if any and amount of irrigation fluid instilled. Document any tests performed with the gastric contents. Shollenberger, D., (2004) Nursing Procedures: Fourth Edition. (pp 551-554). Lippincott Williams and Wilkins. Philadelphia: PA..

REFERENCES:

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GASTRIC LAVAGE (spe10)

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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, ICU Paula Hopper, RN, BSN, Clinical Educator, ECC APPROVAL: Nursing Standards and Practice, 8/7/08