Gastric Lavage - What size tube?

[JessicaSN]

We don't do gastric lavage very often in my ER, but the doc wanted it done on a young lady recently (swallowed multiple types of meds 30 minutes before arrival). We tried out the "garden hose" tubes without success and ended up placing an 18 French. Unfortunately our ER doesn't have a wide variety of choices - we go from 32 to 28 to 18 and smaller. So my question is....

What is the largest size NG tube you have placed for the specific purpose of doing gastric lavage on an overdose? I'm not talking about NG tubes for suctioning bleeds or bowel obstructions. When you need to lavage to suction out large pieces of pills, what size NG do you use? I'm not taking about OG either

Thanks

[BrnEyedGirl, BSN, MSN, RN, APRN]

In my 10 yrs in the ER I've never lavaged an OD.

[Lunah, MSN, RN]

Sheehy's Emergency Nursing: Principles and Practice first mentions that gastric lavage is not recommended in most situations (even for recent pill consumption), and has not demonstrated a clinical benefit. "In fact, only a small percentage of ingested material is retrieved through gastric lavage. Even the widest tube may not accommodate pill clumps, whole tablets, or extremely large fragments."

However, the text says if you're going to do it, use a 36F-40F orogastric tube with a bite block if you suspect there are pill fragments. Anything smaller will probably clog and be useless. I have seen gastric lavage done once in our ED, and that was probably 5 years ago.

[F.E.R.N., BSN, RN]

Interesting question...what about NGT size for putting charcoal down an intubated patient? We use the actuall lavage oral kits for true lavage, but we often get orders for charcoal via an NGT. VERY difficult.

[ThrowEdNurse, BSN, RN]

we only use the full on lavage kits with the built in tubes the size of my fist. But I would think that if you can crush pill fragment small enough to put down an average peg tube, then something similar in size could remove partially digested pill fragment.

[gardengal1, ASN, RN]

We use the standard lavage kit which comes with a 32 F OG tube. We used to do this a lot but now, with it falling out of favor, I have done this once in the past 4 years. BUT, the charcoal goes down this tube MUCH easier than trying to put any charcoal through any NG tube! I do not know why anyone would think a 32 F could not remove pills or pill fragments - I have seen many pills and pill fragments come back in the return bag when we used to do this. Of course, we have no way of knowing how much of the pills we get back but they were visible in the return fluids.

[Medic2RN, BSN, RN, EMT-P]

I've done gastric lavage three times in the past year using a lavage kit with an OG. Like Gardengal1 stated, the pill fragments came out without any problems and instilling charcoal was easy.

Sorry, I never inserted an NG for this reason.

[karrncen]

As LunahRN stated, lavage is no longer recommended. Even if you retrieve pills and fragments, there is significant risk of trauma to the oropharynx and esophageal mucosa. You will still be administering charcoal and monitoring because there is no way of being certain you will remove all of the ingested material.

[MassED, BSN, RN]

Interesting question...what about NGT size for putting charcoal down an intubated patient? We use the actuall lavage oral kits for true lavage, but we often get orders for charcoal via an NGT. VERY difficult.

it's the worst when you try to thin it ahead of time with some water and when you are pushing it down the NG tube, it squirts back. I learned early on that Charcoal doesn't come out of scrubs.

[canoehead, BSN, RN]

We used to lavage every OD, just like a reflex. Even if it was 2 pills, or something that would just wear off with time. It was like revenge on the suicidal person. They might come in cooperative, but you could be darn sure we'd make them rue the day. It's such a relief to not have to do that anymore. We'd have five people covered in vomit and charcoal, and a weeping screaming patient, and crying family. Just unbelievable that it wasn't questioned before.