Lesson 38. Lavage
a. Introduction. Gastric lavage is the washing out of the stomach via a nasogastric tube or stomach tube. Lavage is ordered to wash out the stomach (after ingestion of poison or an overdose of medication, for example) or to control gastrointestinal bleeding. If the patient does not have a nasogastric tube in place already, the physician will order the insertion of the appropriate tube. For a stomach wash, the physician will probably order the insertion of an Ewald stomach tube or a large lumen nasogastric tube. To control gastrointestinal bleeding, a large lumen Levine tube or Salem sump tube will be inserted. In the event of severe bleeding, as in the case of esophageal varices, a Sengstaken-Blakemore tube will be inserted. A large lumen tube is preferred, since particles of food or other material may occlude the lumen of a small tube. The tube must be checked to verify proper placement in the stomach prior to proceeding with lavage.
b. Equipment. Gather the following equipment and take to the patient's bedside.
- (1) Syringes, 2 or more, 50cc catheter tip.
- (2) Washbasins, 2 (to collect used solution).
- (3) Bath towels.
- (4) Chux pads.
- (5) Emesis basin.
- (6) Paper tissues.
- (7) Graduated container for measuring.
- (8) Prescribed lavage solution (usually, normal saline solution).
- (9) Suction equipment readily available.
c. Preparation. Prior to beginning the procedure, check to be certain that you have prepared everything you will need.
- (1) In most gastric lavage procedures, the physician's order will be to lavage "until clear." This means that the lavage procedure will be repeated until the stomach contents that are returned are clear, that is, nothing returned except the irrigating solution itself. This requires that you be prepared with at least 6 liters of solution. You may not need to use it all, but you should have it available at the bedside.
- (2) If the lavage procedure is being done to control gastrointestinal bleeding, the order will probably be "ice lavage." Chilling the solution with ice will promote constriction of the blood vessels, thereby helping to control bleeding. Again, you will need to have quite a bit of iced solution on hand and ready for use.
- (3) Position of the patient for lavage will depend upon the patient's tolerance and the physician's preference. Lavage may be done with the patient sitting or lying. Placing the patient on his left side with the HOB elevated 15 degrees will allow the tip of the tube to lie in the greater curvature of the stomach.
d. Lavage Technique. There are two basic techniques used in performing gastric lavage. The technique used depends upon the reason for the procedure and the physician's preference. Check the doctor's orders to see which method is specified. If the physician does not specify the technique, consult with the professional nurse. The two techniques used are as follow.
- (1) Solution is instilled and aspirated 50cc at a time, using a catheter tip syringe. The procedure is repeated until the stomach contents return clear, the entire amount of prescribed solution has been used, or otherwise directed.
- (2) Solution is slowly poured into the tube through a funnel, allowing the solution to enter the stomach by gravity. Up to 500cc of solution may be instilled at a time, depending upon the size and tolerance of the patient. The tube is then lowered below the level of the patient, allowing the solution to drain out of the stomach by gravity. When using this technique to lavage, it is imperative that the patient be assessed carefully for abdominal distension. Repeat the procedure until the stomach contents return clear, the entire amount of solution has been used, or otherwise directed.
- (1) Assemble the necessary equipment.
- (2) Identify the patient and explain what is to be done.
- (3) Position the patient and place an emesis basin and paper tissues within reach.
- (4) Drape the patient with towels or paper chux to absorb any drainage.
- (5) Verify tube placement by aspirating stomach contents.
- (6) Place the stomach contents in a labeled specimen container for examination by the physician and/or laboratory analysis.
- (7) Instill lavage solution, using one of the techniques described above.
- (8) Remove the lavage solution, using one of the techniques described above, as appropriate to the method of administration.
- (9) Continue to lavage until stomach contents return clear, the prescribed amount of solution has been used, or as otherwise directed.
- (10) Continually observe the patient for cyanosis, increased respiration’s, gagging, and attempts to vomit. If the patient vomits, support his chin in hyperextension to keep the airway open and prevent aspiration.
- (11) When lavage is completed, clamp the tube if it is to remain in place.
- (12) If the tube is to be removed, clamp or pinch off the tube and withdraw it quickly and smoothly. Place it in a basin or chux.
- (13) Remove all used equipment from the bedside.
- (14) Measure the total lavage return. Estimate the amount of stomach contents by subtracting the known amount of solution used from the total. Record on the I&O worksheet.
- (15) Discard lavage solution.
- (16) Dispose of equipment in accordance with local SOP.
- (17) Record the procedure in the patient's Nursing Notes. Note the following information.
- (a) Type and amount of lavage solution used.
- (b) Appearance, odor, color, and amount of gastric return.
- (c) Patient's tolerance to procedure.
- (d) Disposition of specimens.