Gastric lavage in Pediatrics

Gastric lavage in pediatrics—also known as stomach wash—is a procedure used to remove toxic substances from a child’s stomach, typically after ingestion of a harmful substance. It must be performed with extreme caution due to the risks involved, especially in young children.

Indications

• Accidental poisoning (except corrosives and hydrocarbons)
• Management of upper GI bleeding
• For collecting samples of gastric juice for the diagnosis of acid-fast bacilli

Equipment Needed

A clean tray containing:

• Ryle’s tube
• Suction apparatus
• Liquid paraffin
• Mouth gag
• Saline or plain water
• Specific antidotes (if the poison is identified)

Preparation for gastric Lavage

• Obtain vital signs.
• Explain the procedure to the parents.
• Place the child supine with head hyperextended and supported underneath by a hand. Restrain the conscious child to prevent injury.
• Ensure adequate airway protection.
• Have all the equipment ready.
• Monitor the vital signs every 15 minutes during the procedure.
• Avoid introducing air into the stomach.
• Ensure that the amount of fluid returned should approximate the amount infused.
• If concretions are suspected (e.g., aspirin), it may be helpful to flex the child’s hips and gently massage the stomach.
• When using dual-plunger system, the simultaneous inflow of lavage fluid and outflow of stomach contents tend to better aspirate stomach contents, yielding more efficient lavage.
• Retching or vomiting commonly occurs when the tube is removed.
• When the lavage has been completed, the same Ryle’s tube may be used for installing activated charcoal before withdrawal.

Procedure

• Wash hands and don gloves.
• Open the mouth and use the mouth gag.
• After lubricating the tube with liquid paraffin (avoid it in a neonate), advance the tube over the tongue toward the back of the throat.
• Keep advancing the tube until the mark on the tube reaches the tip.
• Confirm that the tube is in the stomach by pushing air through the tube and auscultating over stomach.
• Bubbling of air when the outer end is placed in a cup of water indicates that tube is in trachea rather than stomach.
• Fix the tube securely on the face with adhesive tape.
• Gently suction the gastric contents.
• Perform lavage of stomach using aliquots of NS (10-100 mL/kg/cycle). The fluid may be infused by gravity or with a syringe, but rapid, forceful fluid injection should be avoided, as this may force stomach contents out of pylorus.
• The lavage fluid is drained by gravity (by holding the end of the tube below the level of the stomach) or removed by syringe aspiration.
• Keep repeating the cycle till the color of the returning fluid is the same as that of the lavage fluid.
• While removing the tube, always pinch its end to prevent spilling of the contents into the trachea.

Post procedure Care

• Keep the child in comfortable position:
• Monitor the vital parameters, including level of consciousness.
• The child should be observed for any respiratory symptoms that might indicate pulmonary aspirations.
• Send the specimen to laboratory (as necessary).
• Document the procedure in record-type of fluid used, total amount, and sequence of procedure with date and time.

General instruction

• The tube may be inserted well through the nostrils
• Do not use excessive force while passing the tube
• Watch out for laryngeal spasm and bradycardia during the procedure
• Monitor the vital signs every 15 minutes during the procedure.
• Avoid introducing air into the stomach.
• Ensure that the amount of fluid returned should approximate the amount infused.
• If concretions are suspected (e.g., aspirin), it may be helpful to flex the child’s hips and gently massage the stomach.
• When using dual-plunger system, the simultaneous inflow of lavage fluid and outflow of stomach contents tend to better aspirate stomach contents, yielding more efficient lavage.
• Retching or vomiting commonly occurs when the tube is removed.
• When the lavage has been completed, the same Ryle’s tube may be used for installing activated charcoal before withdrawal.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285

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