GASTRIC GAVAGE and

GASTRIC LAVAGE

Is the introduction of nourishment into the stomach by means of a tube passed through the nose or mouth (naso or oro -gastric) or through a surgically created hole in the person's neck, chest, stomach, or intestines.

Gastric Gavage

To provide nourishment with food and or medication if oral route is inaccessible.

Indications:1. Gastrointestinal diseases and surgery2. Hypermetabolic states (burns,multiple

trauma,sepsis,cancer)3. Certain neurologic

disorders(stroke,coma)4. Following certain types of surgery (head and neck, esophagus)

Contraindication: Absent bowel sounds

Purpose :

Nasogastric tube1. Tube is placed in either nostril, passed down the

pharynx through the esophagus and into the stomach .2. (36” to 45”.)3. used for those individuals who are unable to ingest

nutrients by mouth (for short term feeding )4. The Placement must be checked before each feeding.

Gastrostomy tube5. The tube goes directly in the stomach through the skin.

It is surgically placed into the abdominal wall. 6. Used for the delivery of long term Enteral nutrition.

Jejunostomy tube7. Is surgically implanted in the upper section of the

small intestine called the jejunum which is just below the stomach.

8. Used to be fed directly into the intestinal tract. The patient must always be fed with an Enteral feeding pump.

Types of Feeding Tube

1.BolusIt is a normal meal feeding pattern.a syringe is attached to the feeding tube and

formula is poured into the syringe, it is allowed to flow into the tube by gravity.

2. Continuous Feeding is administered continually for 24

hours through infusion pump.3. Cyclical Feeding is administered in the day time or

the night time for 8 hours to 16 hours. Feeding given through infusion pump. Feeding at night allows more freedom

during the day.

Types of Administration

Change the feeding container and tubing every 24 hours.

Do not hang more solutions that will require for 4 hour period to prevent bacterial growth.

Check the expiration date on the formula before administering.

Shake the formula well before giving. Always assess placement of the tube before

feeding. Always assess bowel sounds, do not administer

any feeding if bowel sound is absent. Administer feeding at prescribed rate or via

gravity flow with 60 ml syringe without the plunger.

Precautions

DiarrheaAspirationClogged tubeVomitingTube displacementElectrolyte imbalance

Complications

Documentation:1. Describe and record procedure2. Time of feeding3. Type of Gavage feeding4. Type and amount of fluid given5. Amount retained or vomited6. Patient’s reaction to the

procedure

A procedure used to empty the stomach of its contents. Performed using a flexible rubber tube that is passed through the mouth and advanced to the stomach.

This procedure includes the instillation of a balanced salt solution into the stomach

(via the tube) followed by suctioning the fluid out of the stomach.

An effective procedure in the treatment of toxic ingestions.

Gastric lavage

An alternative for gastric lavage is the oral administration of activated carbon, (50-100g) as a single dose to reduce drug absorption , a form of carbon with a large surface area for binding poisons, preventing absorption by the gastrointestinal tract

Drugs not adsorbed by activated charcoal (metals, alcohols, acids, alkalis)

Alternative

1. Potentially life-threatening poisoning (or history is not available) and unconscious presentation

2. Potentially life-threatening poisoning and presentation within 1 hour

3. Potentially life threatening poisoning with drug with anti-cholinergic effects and presentation within 4 hours e.g. atropine

4. Ingestions of sustained release preparation of significantly toxic drug

5. Large salicylate poisonings presenting within 12 hours

6. Iron or lithium poisoning

Gastric lavage should be considered in :

Corrosive ingestions or oesophageal disease in patients at risk of gastrointestinal hemorrhage

or for poisons that have an effective antidote.

Contraindications

Poison/Drug Antidote

paracetamol (acetaminophen) N-acetylcysteine

vitamin K anticoagulants, e.g. warfarin

vitamin K

opioids naloxone

iron (and other heavy metals)desferrioxamine, Deferasirox or Deferiprone

benzodiazepines flumazenil

ethylene glycolethanol or fomepizole, and thiamine

methanolethanol or fomepizole, and folinic acid

cyanideamyl nitrite, sodium nitrite and sodium thiosulfate

Organophosphates Atropine and Pralidoxime

Magnesium Calcium Gluconate

Calcium Channel Blockers (Verapamil, Diltiazem)

Calcium Gluconate

Beta-Blockers (Propranolol, Sotalol)

Calcium Gluconate and/or Glucagon

Isoniazid Pyridoxine

Atropine Physostigmine

Thallium Prussian blue

ANTIDOTES

1. Protect airway (endotracheal intubation) if patient is stuporous or comatose

2. Lie patient on their left side 3. Insert a large bore double lumen orogastric

tube 4. Aspirate stomach contents 5. Use a small cycle lavage of 50-100 mL (and

then aspirate) 6. Lavage is rarely indicated beyond 5 minutes,

unless tablets are still actively being returned 7. It is no longer recommended to have a

completely clear return before ceasing gastric lavage

Technique

1. aspiration pneumonia 2. laryngospasm 3. hypoxia 4. bradycardia 5. epistaxis 6. hyponatremia 7. hypochloremia 8. water intoxication

Complications

THANK YOU