This document provides instructions for performing gastric lavage to obtain specimens for tuberculosis diagnosis in young children. Gastric lavage involves passing a lubricated tube through the nose into the stomach of an infant or child under age 2, injecting saline, withdrawing an equal volume into a labeled container, and transporting it to the laboratory within 4 hours for microscopy and culture. Safety precautions like wearing masks are recommended due to risk of generating tuberculosis aerosols during the procedure.

1. Gastric Lavage
In
The diagnosis of tuberculosis
in young children

2. Gastric lavage
• Gastric lavage is the standard method of
obtaining specimens for TB diagnosis in
young children.
• It is generally carried out only in infants
and children below the age of two years.
• In older children specimens for TB
microscopy and culture are better obtained
by sputum induction, or voluntary
coughing.

3. It is best to perform the lavage first thing in
the morning before the child has had food
or drink.

4. The procedure
• First explain the procedure fully to the
parent or caregiver.

5. The procedure (continued)
• Place the infant or
young child in the
supine position, and
have an assistant
restrain the child and
flex the head slightly.

6. The procedure (continued)
• Select the appropriate
tube. Determine the
length to be passed
by measuring the
distance for the
manubrium sterni to
the xiphisternum.
Double this and add
5cm. Mark the
appropriate length on
the tube.

7. The procedure (continued)
• Lubricate the lower 3-4cm
with KY jelly, and pass it
through a nostril toward
the occiput (not vertex).
If resistance is
encountered, withdraw
the tube and try the other
nostril. Continue even if
gagging occurs but
withdraw immediately if
there is severe coughing,
choking or cyanosis.

8. The procedure (continued)
• Introduce the selected
length and fix the tube
lightly to the cheek.
Aspirate the tube and test
the contents with litmus
(blue to red indicates
acid). If no fluid is
obtained advance the
tube 3cm and try again.
If still unsuccessful, inject
3m of normal saline.
Withdraw the tube if this
causes coughing.

9. The procedure (continued)
• Using a syringe, draw
sterile 0.9% NaCl for
lavage from a 20ml
ampoule: 5 –10 mls
for babies less than 1
year and 10-20 mls
for babies older than
1 year. Inject NaCl
into the stomach
through the tube and
leave for 2-3mins.

10. The procedure (continued)
Withdraw a volume equal to that of the
normal saline injected and collect into a
50 ml tube containing 100mg of sodium
bicarbonate.

11. What to do with the specimen
• Screw the cap tightly closed.
• Invert the tube 5 times to mix contents.
• Label the jar with the aspirate as follows:
– Child's name
– Name of hospital
– Place a patient identification sticker on the jar, with the
number (1 or 2) and type of specimen(i.e. gastric lavage)
– Date and time of collection.
• Complete a request form for the laboratory and place a
patient identification sticker on this form.
• Place the specimen in a plastic bag together
with the request form, and keep in the ward
refrigerator (NOT freezer) or in a cooler box
containing ice packs.

12. What to do with the specimen
• Transport specimens to the laboratory as soon
as possible after collection, but in any case
within a maximum of 4 hours:
– Specimens should be placed in a closed 3kPa screw
cap transport container containing sufficient absorbent
material to absorb any potential spillage.
– The 3kPa container should then be placed in a
secondary transport box containing an ice pack. This
box must be clearly labeled as biohazardous and
containing potentially infectious material.

13. What then?
• Then give the usual milk feed

14. What then?
• Obtain two specimens per patient (on
consecutive days).
• Specimens should not be collected over
weekends unless unavoidable, in which
case they will be placed in the
refrigerator whilst awaiting collection

15. Safety issues:
• Since insertion of the nasogastic tube may
induce coughing, there is a possibility that M.
tuberculosis aerosols may be generated.
• Staff present in the ward should wear N95
respirator masks throughout the procedure.
• All potentially contaminated devices should be
discarded or sterilized before re-use.