Gastric Gavage &

Control GI bleeding
Mary Grace R. Tria, RN, MAN
 Intended Learning Outcome
1. Be able to determine the Gastric Lavage (Tube) Feeding (Nursing
Procedure).
2. Be able to recognize the ways on how to control GI bleeding.
Gastric Gavage
Mary Grace R. Tria, RN, MAN
 • is a means of supplying nutritional
substance via a small plastic tube
Gastric Gavage direct to the stomach
What are the indications???
 Gastric Gavage
Indications:

1. Patients who have the inability to ingest, swallow or chew foods but
are able to digest and absorb nutrients require feeding via tubes.

Tube feedings deliver liquid feeding formula directly to the stomach,

duodenum or jejunum.
• Duodenum (first part of your small intestine).
• Jejunum (middle part of your small intestine).
• Ileum (the last section of your small intestine).
 Gastric Gavage
Indications:

2. For a patient who cannot normally eat due to dysphagia, oral

or esophageal obstruction or injury.

Dysphagia (medical term for swallowing difficulties) In addition, it

is indicated to patients who are unconscious, intubated or those
recovering from GI tract surgery and cannot ingest food orally.
 Gastric Gavage : Equipment Needed

• Feeding formula
• Bulb syringe
• 120 ml water
• Gavage bag with tubing and flow regulator clamp
• Towel or linen-saver pad
• 60 ml syringe
• pH test strip
 Preparation of Equipment

1. Check the feed formula containers for expiry dates.

Discard expired formulas.
2. Powdered formulas should be used within 24 hours of
mixing.
 Preparation of Equipment

3. Shake the container well to mix the solution thoroughly.

4. The formula should be warmed to room temperature before

feeding.

Administering cold formulas can increase the chance of diarrhea.

Do not warm the formula in direct heat or microwave as it may
cause the solution to curdle and the chemical composition. Also, a
hot formula can injure the patient.
 Gastric Gavage(Tube) Feeding Procedure

1. Confirm patient’s identity using two patient identifiers

according to your facility’s policy.
2. Verify physician’s order. Tube feedings MUST be ordered
by a physician. The order will indicate the type of
formula to be used, route, amount to be
administered and frequency of feeding.
 Gastric Gavage(Tube) Feeding Procedure

3. Provide privacy and explain the procedure to the patient.

4. Place a towel or linen-saver pad on the client’s chest to
protect him from spills.
 Gastric Gavage(Tube) Feeding Procedure

5. Position the patient in a high-Fowler’s position (30 to 45

degrees). Inform the patient to remain in this position during
and 1 hour after feeding to limit the risk of aspiration and
reflux.

6. Wash hands and don gloves.

 Gastric Gavage(Tube) Feeding Procedure

7. Assemble equipment.
8. Check the placement of the feeding tube to verify the correct placement of the tube in the
stomach.
• NEVER administer a tube feeding until you are sure the tube is properly positioned in the
stomach. Administering feeding through a misplaced tube can cause the formula to enter the
lungs. To check tube patency and position, remove the cap or plug from the tube feeding and
use a syringe to aspirate stomach contents. Examine the aspirate and place a small amount on
the pH test strip. The tube is patent if the aspirate has a pH of 5.0 or less. If pH is higher, do
not proceed to feed, inform the physician as the tube may be displaced. Another way to check
the placement of the tube is by obtaining an x-ray film for tube placement.
• NOTE: In the past, insufflation of air into the tube was followed by auscultation of abdominal
sound. This technique is no longer considered reliable in determining the placement of the
tube.
 Gastric Gavage(Tube) Feeding Procedure

9. Assess gastric emptying by aspirating and measuring residual

gastric contents. If the residual volume is greater than 150ml or
the predetermined amount specified in the physician’s order, hold
feedings. Reinstill any aspirate obtained.

10. Observe the abdomen for distention to assist in recognizing

delayed gastric emptying and decreases the risk of regurgitation
and pulmonary aspiration due to gastric distention.
 Gastric Gavage(Tube) Feeding Procedure

11. Auscultate abdomen for bowel sounds to check the presence of peristalsis and
ability of GI tract to digest nutrients.
• Bolus or intermittent feeding: (a) Pinch the proximal end of the feeding tube to
prevent excess air from entering the patient’s stomach, causing distention. (b)
Attach the syringe to the end of the tube and elevate it 18 inches above the head of
the patient. (c) Pour the formula into the syringe. Allow the syringe to gradually
empty. Refill syringe until the ordered amount has been consumed.
• Continuous-drip method: (a) Hang gavage bag to an IV pole. The patient should be
checked every 6-8 hours. (b) Connect the end of the bag to the proximal end of the
feeding tube. (c) Connect the infusion pump and set the rate.

12. Administer tube feeding.

 Gastric Gavage(Tube) Feeding Procedure

13. Flush the tubing by adding 60 ml of water to the gavage

bag or bulb syringe, after administering the prescribed
amount. This maintains tube patency by removing
excess formula which could occlude the tube.
14. Cover the end of the feeding tube with its plug or cap or
clamp the proximal end of the feeding tube to prevent
leakage and contamination of the tube.
 Gastric Gavage(Tube) Feeding Procedure

15. Remove and dispose of gloves in a proper receptacle.

16. Document time, amount and type of feeding.
 Gastric Gavage
• The body requires food to provide energy for organ function,
replace and repair cells and speed up recovery from illness.
• Hence, for patients who have trouble swallowing or chewing
food, gastric gavage feeding is one important procedure
nurses have to implement and master.
Controlling GI Bleeding
Mary Grace R. Tria, RN, MAN
• Gastrointestinal (GI) bleeding is a symptom of many digestive
system disorders, including reflux, ulcers and cancer. It can occur in
any part of the digestive system (GI tract), which runs from the
mouth to the anus.
• Bleeding can be mild and ongoing or come on suddenly and be
life-threatening.
 How do you control gastrointestinal
bleeding?
GI bleeding often stops on its own. If it doesn't, treatment depends on where the bleed is
from.

In many cases, bleeding can be treated with medicine or a procedure during a test.
Healthcare providers deliver GI bleed treatments during an endoscopy or colonoscopy.
Tiny instruments at the tip of the endoscope or colonoscope make it possible to: Remove
abnormal growths, such as colon polyps. Inject medications that help the body stop
bleeding.

For example, it's sometimes possible to treat a bleeding peptic ulcer during an upper
endoscopy or to remove polyps during a colonoscopy.
References

1. Fundamentals of Nursing, Potter and Perry

2. Best Practices, Lippincott Williams & Wilkins
3. https://my.clevelandclinic.org/health/diseases/23391-gast
rointestinal-gi-bleeding
Thank you!
Have a nice day.