Lavage and the GI bleed

mianders, RN · Feb 25, 2008

I have not been in the ER in 2 years , but when I left we were still doing "lavage until clear". Then they were usually put on a sandostatin drip. I could not tell you if that has changed.

S.T.A.C.E.Y, LPN · Feb 26, 2008

Not here.

Pantoloc bolus & infusion, and an octreotide infusion sometimes too.

stardogdaisy, RN · Feb 26, 2008

My latest experience with an active GI bleeder was Nasogastric lavage until clear. The patient was then started on octreotide and protonix continuous IV drips. Then to the ICU they go...that is, if they are "ready to take the patient or even report." But that is a whole separate issue.

nursingisworkRN · Feb 26, 2008

Our ED is the same as Stardogdaisy. Oh yeah, and don't forget the dual 16g :wink2:. Last guy I had was young with a hemocue of 5, and he got 14's. He had to wait in the ED for 12 hours, and I think he liked the lavage. At least, he asked me to do it again after nightshift went home. He did have coffee ground blood. Not sure about active bleeding.

stardogdaisy, RN · Feb 26, 2008

Oh, yes, always two large bore peripherals. And this lady was actively bleeding...ETOH abuse for many years. Very sad, she was only 39yrs old. We were giving blood and pumping her full of fluids. I don't think that the units or the floors realize that we have to get these patients out of the ED as soon as possible. We are short staffed just like they are, but we cannot do one on one care when we have four or five other sickies. Sorry, just venting.:uhoh21:

suanna · Feb 26, 2008

The last conversation I had with one of our GI docs was that the practice was no longer recommended unless you want to decompress the stomach--pt vomiting or concern that blood can act like a cathartic in the intestines. The risk you take is that if the bleed has clotted off you will dislodge the clott and start it up again. Removing the clotts in the stomach dosn't help the bleed at all. If we lavage at all now it is usualy with meds not "till clear". We used to do iced lavage till clear but the hypothermia often made the problem worse. As far as drugs- does anyone else use neosynepherine(phenylephrine) in the lavage for capillary constriction? One of our docs swears by this.

rlgiv · Feb 27, 2008

In my ER all I remember doing is an NG.

rgroyer1RNBSN, BSN, RN · Feb 27, 2008

We do it occasionally, I think it depends on the doc. Usually we the new docs, we drop an ng we just dont lavage it, they just want ti in place in case we need it, 2 large ore Iv's, Protonix, Octreotide, ABX, Blood, Pain and Anti-emetic meds.

KckStrt · Feb 27, 2008

My latest experience with an active GI bleeder was Nasogastric lavage until clear. The patient was then started on octreotide and protonix continuous IV drips. Then to the ICU they go...that is, if they are "ready to take the patient or even report." But that is a whole separate issue.

Do you work with me? LOL... I love this. :lol2:

b eyes · Mar 1, 2008

I had to do this about 2 months ago maybe on a jehovah's witness int the back of an ambulance for 1 hour and ten minutes to a level 2 trauma center (we are level 4). Patient was very messy by the time I got there, however he was alive and he is still alive!!

b eyes

KatieBell · Mar 2, 2008

Pretty much everywhere I have worked we are still NG lavage until clear. If the patients belly is full of blood, Getting the blood out can reduce nausea, and we have an idea of how much is coming out. Will never forget a guy who looked quite fine, albeit a little pale, who dumped out 3litres of blood immediately afterI put him to suction. Not a fun night as he was stuck in a teeny room (The one we had available.)....

other than that, 2 large bores, protonix, oxygen, and monitoring. Dont forget the Oxygen.