Have you used code blue lavage/gavage?

  1. We have been inserviced on the code blue system and everyone seems apprehensive to use it. Our ER docs let the RN choose the NG or code blue at this time...they just want it done.
    Any pros/cons or tips from those that have used it??
    Thanks, Karen
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  2. 24 Comments

  3. by   ERQueen
    Are you talking about an EWOL vs. NGT?
  4. by   KKERRN
    We don't have the EWOL. The code blue is oral vs. NGT and we will use a bite plate that the tube can be inserted through. This system has a dual syringe attachement to insert lavage and remove gavage manually instead of by wall suction. Has a large drainage collection bag attached also.
    We haven't used oral tubes. We had a #24 size lavaculator NGT we could place orally, but seldom did so.
    The inservice instructor tells me the whole lavage/gavage could be done in 10 minutes once we get used t usingthis system. It will take 2 people...one to hold the jaw shutaround the bite plate while the other inserts and performs the procedure.
    Is that how the EWOL tube works?
    Thanks,
    Karen
  5. by   2ndCareerRN
    We use the Code Blue Easi-Lav.

    It is very easy to use, almost takes as much time to set up as it does to do the lavage.

    I personally like it. I can pump 3L through a person in a matter of minutes. It will also bring up fairly large chunks without clogging up. And if the return is not clear after the first 3L the supply bag can be refilled.

    A few pointers.
    Have the person lying on their side if possible...helps prevent a vagal response from that 34 french tube down their gullet, and a possible aspiration.

    Have suction ready to go, the person invariably vomits some around the tube at first.

    Place the drain bag into a kick bucket with a plastic bag, it sometimes leaks, or the clamp may be forgotten.

    If your charcoal does not attach directly to the supply side of the pump syringe, you can just clamp the return side tube and pour the charcoal into the supply bag and then pump it in.

    It does take at least 2 people, except for the frequent flyer I used to see. He would place the tube himself and tell you when to start. He was way to experienced at the procedure!!

    You may want to consider wrist restraints if you think the person will try to remove the tube while you are doing the procedure. After you have used it one or two times it becomes very easy.

    bob
  6. by   ERQueen
    It sounds like our EWOL tubes. They are usually 34 French oral tubes, although our docs have putten them in nasally before... OUCH! It comes with a bite block, but it only takes one person to do the system. We only use them if it's a big overdose. After the tube is in we secure much like we secure ETT's. You attach the tube to a two-bag system. You hang the "in" bag on an IV pole and lay the "out" bag in the floor. From there you just clamp and unclamp until clear.
  7. by   LBLOCKRN
    We use the Code Blue Easy Lavage
    ours comes in 2 sizes 34f and 18f- we usually use this for
    big overdoses that need lavage and charcoal, we use the charcoal with sorbitol in a tube that attaches right into the system. It takes some practice and it does come with that cool instruction sheet ( with pictures) if you get lost ,I have been an ER nurse for a long time and still find that pictures are a good thing.
    We do usually save the 34 french for really sick overdoses (bad stuff that really kills people) and those really special patients.
  8. by   KKERRN
    Thanks for your responses and tips. We haven't used the system yet, but it sounds like it will be faster than the NGT route.
    Our code blue has an instruction paper with pictures also included with each package.
    The sorbital comes with the package and will attach to the input syringe.
    The instructor didn't mention to have the person on their side to prevent the vagal response. I'm glad you gave me that tip prior my first attempt at this!!
    Thanks again,
    Karen
  9. by   teeituptom
    Howdy yall
    from deep in the heat of texas


    KkERRN, once you get used to it, you will absolutely love it, fast and easy. We use the 34 fr for all adults, it is great.






    doo wah ditty
  10. by   2ndCareerRN
    The instructor didn't mention to have the person on their side to prevent the vagal response.
    Sometimes it is impossible to lie the (conscious) person on their side so we do them sitting up at ~45 degrees, with the bed raised and trendelberged (so they don't slide off the end).

    Lying on the left side is also supposed to keep the irrigation fluid from pushing the toxin into the duodedum, where it would be absorbed more rapidly.

    I think most of the ones I have done have been done with the person semi sitting, unless they were completely out. If unconscious it is left lateral with the head down. We also use it for ETOH overdose, to ensure all the ETOH is out of the stomach. I have seen BAC go up from initial entry to ER to a few hours later, because they come in with a tummy full of beer, or whatever. Besides, I would rather pump it out than have them throw that foul smelling stuff up.

    bob
  11. by   KKERRN
    Bob & Tom.
    I work this weekend...maybe I'll get a chance to use the system.
    Again, thanks for the tips. Sounds like this will be a good change for the nurses and the patients both!
    Thanks,
    Karen
  12. by   KKERRN
    Another RN used the code blue this weekend and I shared the tips you gave me. She said the tube went down so quick, but the pt vomitted and while being suctioned pt was able to pull it out. Apparently her right hand wasn't restrainted well enough!!!
    The output bag seems to come with a flemsy/cheap hook to hang the 3000cc bag and they used the kick bucket!
    Thanks again for the tips,
    Karen
  13. by   seastir
    I havent used gastric lavage in about 3 years. We just dont use that intervention these days......just charcoal em. When I did use them, I hated them. In the rare case there were pill fragments there, they often obstructed the tube (along with food!). Just a mess to deal with.....vomiting around the tube, traumatic for the patients...
  14. by   KKERRN
    seastir,
    I like your way better! We still have to use nasal or gastric lavage first. Why did you get to change?
    thanks,
    Karen

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