What is correct way to do gastric lavage using NGT?

CraigB-RN, MSN, RN · Mar 5, 2015

The key with the poison review article is not "routine" Still indications though. There are some things you have to watch for.

1. If pills were just taken, then they can clog an NG tube. Hence the Ewald. Yes I've been doing this long enough when that was routine. It i impresive when you come across the patient that can swallow the ewald

2.Depending on what they took you have to watch for aspiration.

3.

4. http://wps.prenhall.com/wps/media/objects/737/755395/gastric_lavage.pdf

5. You choose your solition based on the goal of the lavage. Are you duluting, deontaminating etc. I've done saline, even used dialysate.

Anna Flaxis, BSN, RN · Mar 5, 2015

really? I thought it was pretty common thing done in ER since it is one of few ways to treat poison/drug od pts. surprising:bored:

There may be instances where gastric lavage is used for poisoning, however it is no longer standard of care.

The take-home lesson for clinicians: No situation mandates that lavage is the standard of care. There are certainly a number of reasonable toxicologists who would not recommend lavage under any circumstance.

Myths of Toxicology: Gastric Lavage : Emergency Medicine News

icuRNmaggie, BSN, RN · Mar 5, 2015

The Ewald tubes are huge and should never be left in for more than 24 hours.

JustBeachyNurse, LPN · Mar 5, 2015

The Ewald tubes are huge and should never be left in for more than 24 hours.

When an Ewald was used for pill recovery of an acute overdose that was witnessed (as in less than 30 minutes from ingestion to Ewald placement) it was placed, removed what could be pulled/lavished. Activated charcoal instilled. Ewald removed & NGT placed. All around an hour tops.

Sassy5d · Mar 6, 2015

We have a gastric lavage kit. Use liter bags of ns. Instill ns, the bottom bag is clamped. Unclamp and repeat until about 3-4 liters were used.

I hate it. There are some older providers that still think its best practice.

allnurses Guide · Mar 6, 2015

In the ED of 15 years ago it was common, had a special lavage set up that had a double barreled syringe, one side pushed water in from the upper bag, the other sucked it out into the drainage bag. It was a large OG, with a bite guard on it, and usually had the pt hands restrained. Once the beer coming out was still so fresh in foamed in the tubing. Only once did I ever see pill fragments. Once the doc got excited thinking it was fresh blood when it was only salsa. Did make it easier to get the charcoal in.

But, it wasn't really doing them any good. By the time we would get an SI with an OD in, the pills were already out of the stomach. As for GI bleeds, the theory was that ice water helped vaso constrict, and so slow the bleeding. Turned out that was also ineffective. Not to mention we were sucking out too many electrolytes.

Now I see NGs just for emptying the stomach to suction, relieving pressure above an obstruction, or to check for blood (in which case we pull it out if negative). The only time it is "lavaged" isn't really a lavage, it is flushing to clear a possible blockage (either in the tube, or to get it off the stomach wall), in which case you want to pull out the same amount you put in.

Checking for placement with auscultation isn't 100% either, you can still get referred sounds from lungs, or tubes that aren't in quite the right place. Checking the pH for gastric acidity is the only "surefire" method at the bedside, after the initial xray to check placement (in the ED, usually checking for more than just that).

foragreatergood · Mar 6, 2015

I have often heard the phrase " getting stomach pumped". Hearing the description of the Ewald tube now I understand where that term came from! YIKES.