Gastric lavage explainable

1. Preparation of Patient and Assisting with the
Following Procedures: Gastric Lavage, NG Tube
Feeding, Gastrostomy Feeding, Fractional Test Meal,
Ileostomy and Colostomy Care

2. NG TUBE
Nasogastric tube is also
known as Ryle's tube

10. Generally,

11. Nursing Considerations
• Provide oral and skin care. Give mouth rinses and apply lubricant
to the patient’s lips and nostril.
• Using a water-soluble lubricant, lubricate the catheter until where it
touches the nostrils because the client’s nose may become irritated
and dry.
• Verify NG tube placement. Always verify if the NG tube placed is in
the stomach by aspirating a small amount of stomach contents. An
X-ray study is the best way to verify placement.
• Wear gloves. Gloves must always be worn while starting an NG
because potential contact with the patient’s blood or body fluids
increases especially with inexperienced operator.
• Face and eye protection. On the other hand, face and eye
protection may also be considered if the risk for vomiting is
high. Trauma protocol calls for all team members to wear gloves,
face and eye protection and gowns.

12. CONTRAINDICATION
•Severe Facial and neck Trauma
•Esophageal stricture
•Recent banding of Esophageal
varices
•Coagulation abnormalities

23. Preparation of Patient and Assisting
with Gastric Lavage

24. Gastric Lavage
• Also called stomach pumping or gastric irrigationor stomach wash
• It is the process of cleaning out the content of the stomach.
• It involve aspiration of the stomach content and washing out by means of a
gastric tube.
• Gastric lavage is used to remove unabsorbed poison or drug ingestion
• It is generally ineffective if more than 60 minutes have passed and the
procedure may delay administration of activated or charcoal antidotes.
• NB; Gastric lavage has small place in modern treatment of poisoning and
some authorities suggest that it NOT to be employed routinely, if ever in the
management of poisonings situations

25. PURPOSES
1. For urgent removal of ingested substances in order to decrease
systemic absorption
2. To empty the stomach before endoscopic procedures
3. To obtain casts of epithelial cells for bacteriological studies
4. To diagnose gastric hemorrhage and arrest hemorrhage
5. Potentially life threating poisoning and presentation in an hour
6. Large salicylate poisoning
7. Ingestion of too much alcohol
8. Before surgery, to clear the content of the GIT

28. CONTRAINDICATIONS
1.Poisons that have effective
antidote
2.In the presence of seizures
3.For patients who have a
compromised, unprotected
airway
4.Ingestion of corrosive
substances
5.Esophageal disease

29. Requirements
(1) Syringes, 2 or more, 50cc catheter tip.
(2) Washbasins, 2 (to collect used solution).
(3) Bath towels.
(4) large bore nasogastric tube
(5) Emesis basin.
(6) Paper tissues
(7) Graduated container for measuring prescribed lavage solution (usually,
normal saline solution).
(9) Suction equipment readily available
(10) large plastic funnel with adapter
(11) Mackintosh and cover

31. Preparation of patient
• Assess airway patency and gag reflex
• Check oxygen saturation
• Pt with unprotected airway, should be intubated
• Check vitals signs –baseline
• Get an IV access
• Toxicology screening –blood /urine specimen for poisoning test
• Measure abdominal girth
• Remove dentures if any
• Position client (fowlers /semi fowlers for ng tube placement then lateral
position for lavage
• If there is already NG tube, check for proper placement before lavage

32. Procedure
1. Explain procedure
2. Protect airway (endotracheal intubation if the client stuporous or comatose)
3. Place patient in the left lateral position to decrease passage of gastric contents into the duodenum during the lavage and
minimize possibility of aspiration into the lungs
4. Insert a large bore lumen orogastric tube (follow steps for passing NG tubes)
5. Aspirate stomach contents with the syringe attached to the tube, before instilling water or antidote. Save the specimen for
analysis
6. Use a small cycle lavage of 50 to100 ml and then aspirate
7. Small amount of saline is administered and through a siphoning action removed again. Saline is preferred to water especially in
children due the risk of developing hyponatremia
8. Lavage is rarely indicated beyond 10 minute, unless tablets are still being actively being returned, in which case lavage
procedure is repeated until the returns are clear
9. At the completion of the lavage, pinch off the tube during removal or maintain suction while the tube is being withdrawn
(pinching off the tube prevents aspiration and the initiation of the gag reflex. Keep the patient’s head lower than the body also
help prevent initiation of the gag reflex
10. Make patient comfortable
11. Document and report findings

33. Complications
1. Aspiration of gastric content
2. Discomfort
3. Esophageal rupture
4. Mechanical injury/trauma to tissue of the throat, sinuses ,esophagus and
stomach
5. Profound bradycardia, laryngospam and hyponatremia
6. Wrong placement. Unwanted scenarios such as wrong placement of an NG
tube into the lungs will allow food and medicine pass through it that may be
fatal to the patient.
7. Other complications include: abdominal cramping or swelling from feedings
that are too large, diarrhea, regurgitation of the food or medicine, a tube
obstruction or blockage, a tube perforation or tear, and tubes coming out of
place and causing additional complications
8. Prolonged use can lead to conditions such as sinusitis, infections, and
ulcerations on the tissue of your sinuses, throat, esophagus, or stomach.

34. NG Tube Feeding

37. Indication
• Dysphagia with frequent aspiration is the most common indication for use of tube
feedings in the elderly.
• Impaired swallowing/sucking
• Facial or esophageal structural abnormalities
• Anorexia related to a chronic illness
• Eating disorders
• Increased nutritional requirements,
• Congenital anomalies
• Primary disease management.
• Enteral feeding tubes can be used to:
• Administer bolus, intermittent feeds and continuous feeds
• Medication administration
• Facilitate free drainage and aspiration of the stomach contents
• Facilitate venting/decompression of the stomach
• Stent the oesophagus

41. Supplies and Equipment
• Gloves Feeding pump (if ordered)
• Clamp (optional)
• Feeding solution
• Large catheter tip syringe (30 mL or larger)
• Feeding bag with tubing
• Water
• Measuring cup
• Other optional equipment (disposable pad, pH indicator strips, water-
soluble lubricant, paper towels

42. Medication Administration through NGT
Nursing Consideration:
• Use medications in liquid form whenever possible.
• If pills or capsules must be used, crush to a fine powder and dissolve
in warm water prior to administering.
• DO NOT crush extended release, enteric coated and sublingual or
buccal forms of medication .
• Most liquid medications may be diluted with water before
administration to minimize development of diarrhea and gastric
irritation.

43. EQUIPMENT
1. PPE
2. Stethoscope
3. >35 mL syringe i.e. Catheter or Luer tip (adults) – pediatrics may use
smaller due to smaller volume used
4. pH test strips
5. Sterile Water (SW)
6. Medication(s) as ordered

44. PROCEDURE
1. Flush feeding tube using push pause technique with 25 mL SW
following EACH medication administration.
NOTE: PEDIATRICS: Flush with 5-10 mL of water.
2. Administer dissolved/diluted medication via syringe into feeding
tube/medication port.
3. Administer each medication separately to prevent drug interactions.
4. Clamp NG following medication administration
NOTE: Contact pharmacy for length of time to clamp tube.
5. : Flush with water after feed
Document

45. Types of Feeding
1. Bolus Feeding
Possibly feed in semi fowlers or upright position during feeding and for at least 30
minutes after the feed to reduce the risk of aspiration.
Feed should be at room temperature
Check placement before feeding
Flush tube with water prior and after feeding
Using a syringe for a bolus feed
Remove the plunger from the syringe and place the tip of the syringe into the NG
tube connector at end of the enteral tube.
Holding the syringe and enteral tube straight, pour the prescribed amount of feed
into the syringe.
Let it flow slowly through the tube e.g. 250ml over 20 minutes.
Pour15-30MLS / the prescribed amount of water into the syringe and allow to flow
through to flush the feeding tube appropriately.

46. Types of Feeding Cont.
2. Continuous feeding: is defined as delivering enteral nutrition with
constant speed for 24 h via nutritional pump
3. Intermittent bolus feeding is defined as delivering enteral nutrition
multiple times, generally giving 15–30 min every 2–3 h by gravity or
electric pump.

50. Administering bolus feed
Administering cont. feed

51. Nursing consideration for client on NG Tube
• Perform oral hygiene daily
• Check tube placement
• Inspect mouth with pen light (observe tube behind the tongue)
• Gastric aspirate for PH testing (1-4)
• Auscultatory method (push about 10-30mls air and auscultate abdomen for
rushing sounds)
• Assess visual characteristic of feeding tube aspirate
• confirmed via x-ray
• Maintain tube patency: flush with water before and after feeding
• Use warm water to declogg obstructed feeding tube
• Monitor client for abdominal distension, abdominal pains and
discomfort

56. GASTROSTOMY FEEDING

57. Introduction
A gastrostomy is a surgically formed artificial opening into the
stomach known as a stoma.
• It is also called a G-tube
• They are commonly surgically inserted endoscopically
through the abdominal wall, and held in place by an internal
balloon or bumper and external fixator.
• Gastrostomy feeding is a successful method of enteral
feeding providing daily nutritional requirements in specialist
liquid form directly into a patient’s stomach via a flexible
tube.

58. Indication
• It is considered for patients who need long-term (4 weeks or
more) enteral tube feeding.
• Birth defects of the mouth, esophagus, or stomach eg.
esophageal atresia or tracheal esophageal fistula
• Problems with sucking and/or swallowing, for example in
patients debilitated by stroke or dementia
NB: Nasogastric tube is preferred for short-term feeding, while gastrostomy
or jejunostomy is indicated for long-term or permanent nutritional support.

59. CONT.
• The tubes come in a variety of types and are referred to according to
the type inserted.
• The commonest types are percutaneous endoscopic gastrostomy
(PEG) tubes and
• low-profile gastrostomy tubes, e.g. Mic-key button™

60. Methods of feeding via a gastrostomy
There are two main methods of feeding via a gastrostomy as detailed
below:
• Bolus feeding: A volume of liquid feed given usually via a gravity set
over a short duration, e.g. 15–20 minutes.
• Continuous feed: This is a feed given via an electronic feeding pump,
which allows clinicians to deliver set amounts of enteral formula in a
consistent manner, over a desired duration of time.

61. Preparation and equipment
• Before administration of feed, preparation is paramount,
therefore simple steps should be adopted as detailed below:
• Collect the appropriate equipment, e.g. syringes (20–50 ml),
gravity feeding set, pump, pump feeding set, gloves, apron,
water for flush.
• Make feed or use appropriate pre-made feed.
• Check the expiry date of the feed.
• Gain informed consent from patient or parent prior to
administration of feed.
• Assess stoma for signs of infection

62. Procedure for bolus feed
• Wash hands.
• Put on gloves and apron.
• Ensure the patient is sitting up or elevated as much as their condition dictates, to help prevent vomiting and
aspiration during the feed and for a period of time after the feed is completed.
• Flush the gastrostomy with approx. 10 ml of water to confirm the patency of the tube.
• Open the gravity feeding pack, which should consist of:
• 60 ml open-ended syringe;
• extension tubing with a roller clamp system;
• Luer lock connector end, with purple and clear capped end.
• Taking the tubing, ensure the clamp is rolled in a downward position, connect the bladder tip syringe on to the
open end of the tubing.
• Take your feed, pour enough feed into the syringe to cover the stretch of the tubing and a little bit more approx.
15 ml.
• Over the sink, roll the clamp slowly into the upward position and gradually prime the tubing till it reaches the
Luer lock end.
• Ensure the clamp is in the downward position.
• Attach the Luer lock end to the appropriate enteral feeding port on the gastrostomy.
• Unclamp, then clamp on the gastrostomy tube.
• Hold the syringe with the feed up and gradually release the clamp until fully open. Reducing the height of where
the syringe is held will slow down the speed at which the feed is administered.
• Once the volume of feed is delivered, clamp down on the administration tube before the milk reaches the end,
and close the clamp on the gastrostomy extension.
• Remove the giving set and flush the gastrostomy using an oral 20 ml syringe filled with a minimum of 10 ml
water (sterile or cooled boiled water for children under the age of one).

63. Procedure for a pump feed
• Collect all the relevant equipment required for the feed as per the bolus feed, including the feeding pump.
• Wash hands .
• Put on gloves and apron.
• Ensure the patient is sitting up or elevated as much as their condition dictates, to help prevent vomiting and aspiration during the
feed and for a period of time after the feed is completed.
• Flush the gastrostomy with approx. 10 ml of water to confirm the patency of the tube.
• Take the feed and the feeding set.
• The tubing extension will have a purple screw top, with a sharp pointed skewer, a length of tubing with a plastic chamber below
the cap and a purple kite-shaped junction half-way down the tubing with a squeezable priming attachment.
• The feed will either need to be decanted into a plastic bottle that will be provided with the extension or will come in a pre-made
bottle with a foil seal.
• Connect the tubing onto the feed.
• Half-fill the plastic chamber with milk by squeezing the sides.
• Hold the milk up in the air, and using the squeezable primer, push until the tubing is fully purged of air and full of milk, ensuring to
stop just after the junction.
• In accordance with the manufacturer’s guidelines for the pump, attach the bottle/bag to the pump and set the rate and the total
volume of feed to be delivered. Ensure the pump is set to hold.
• Attach the Luer lock end to the appropriate enteral feeding port on the gastrostomy.
• Unclamp, then clamp on the gastrostomy tube.
• Ensure the clamp is released on the gastrostomy extension if relevant, and turn the pump dial to run.
• Once the volume of feed is delivered, close the clamp on the gastrostomy extension and detach from the pump.
• Remove the giving set and flush the gastrostomy using an oral 20 ml syringe filled with a minimum of 10 ml water (sterile or cooled
boiled water for children under the age of one).

64. NURSING CARE /CONSIDERATION
• Daily Anthropometric measurements :
height, weight, triceps skinfold, subscapular skinfold, arm
circumference, abdominal circumference, calf circumference,
knee height, and elbow breadth
• Nutritional assessment of recording any weight change;
• determining albumin, prealbumin level

67. FRACTIONAL TEST
MEAL

71. Indication
Discuss

74. Ileostomy and Colostomy
Care

75. Stoma Care
• Wash your skin with warm water and dry it well before you attach the
pouch.
• Avoid skin care products that contain alcohol. These can make your
skin too dry.
• Do not use products that contain oil on the skin around your stoma.
...
• Use fewer, special skin care products to make skin problems less
likely.