Gastric Lavage-Stomach Wash

Subject: Fundamentals of Nursing

Overview

Gastric Lavage/Stomach Wash

Definition

It is washing out of stomach with a solution using a lavage set. It is also called as stomach/ gastric irrigation.

Purposes

  • To obtain samples of gastric contents for laboratory studies.
  • To relieve nausea and vomiting in case of acute gastric dilatation of stomach, pyloric stenosis and intestinal obstruction.
  • To reduce gastric bleeding.
  • To stimulate peristalsis.
  • To reduce temperature in hyperpyrexia and heat stroke.
  • To remove poisonous or irritating substances from stomach.
  • To prepare the patient for gastric surgery.

Articles

  • Ryle's tube of appropriate size (12-14 Fr)
  • Bowl of water / normal saline / or specific solution ordered.
  • Water soluble lubricate / vaseline
  • A funnel to attach to the NG tube
  • Stethoscope
  • Kidney tray
  • Towel
  • Small mackintosh Clean gloves
  • Apron
  • Mask
  • Adhesive tape and scissors
  • Bucket/container for return flow.
  • Syringe
  • Mouth gag.

Solutions Used

  • Plain water (plain water is particularly useful when the poison is unidentified).
  • Normal saline.
  • Weak solution of sodium bicarbonate or boric acid in corrosive poisoning.
  • Antidotes in case of identified poisons.

                     - Physical antidotes: These dilute the poison, prevent its absorption or soothe and protect the mucous membrane.

                     - Chemical antidotes: These neutralize the poison.

Procedure

S.N. Nursing Action Rationale
1 Review the physician's order. Clarifies the rational for enema.
2 Explain procedure to the patient. Promotes patient's cooperation and reduces anxiety.
3 Close the door and screen the patient. Maintains privacy.
4 Wash hands with soap and water.

Reduces the transmission of microorganisms.
5 Bring the articles to the patient's bedside. Aids for smooth functioning.
6 Raise the bed to appropriate working height. Promotes good body mechanics.
7 Wash hands and Wear gloves. Prevents cross infection.
8 Prepare solution at the required temperature. Ensures client's comfort.
9

Remove denture if present and insert a mouth gag.

 Minimize risk of aspiration and risk.
10 Place the patient in left lateral position.

Prevents aspiration of fluid into lungs.
11 Place the mackintosh and towel. Prevents from soiling.
12

Pass lubricate nasogastric tube slowly and gently

Ensure proper placement of tube.

 Makes easy insertion and prevents trauma to the tissues.
13 Secure the tube with adhesive tape. Prevents displacement of tube.
14 Attach the syringe to the tube and aspirate the gastric contents completely and save it for laboratory analysis. Provides specimen for diagnosis.
15 Remove the syringe and attach a funnel to the tube and fill the funnel with irrigating fluid. Raise funnel to allow fluid to run into the stomach. Allow (2-3) funnels of fluid 150-200 ml to flow into the stomach. Ice cold water is used for irrigation when bleeding is present.
16 When (2-3) funnels of fluid have run into the stomach and before the funnel is completely empty, pinch the tube, wait for one minute and invert the funnel over a receptacle and allow the fluid to siphon back/aspirate using 50 cc syringes. Inversion of funnel helps in return flow from stomach.
17 In case of GI bleeding, if blood increases in the outflow, stop the procedure and inform the physician. Prevents further complications.
18 During the nursing procedure observe the patient's vital signs and degree of consciousness in every 15 minutes. Monitors any deterioration in the condition of the patient.
19 Lavaging usually requires a total volume at least 2 liters.  
20 Discontinue the treatment, by pinching the tube and pulling it out quickly. Prevents entry of air into stomach.
21 Give a mouth wash and dry the face. Patient feels comfortable.
22 Remove gloves and wash hands. Prevents from contamination.
23 Keep patient in comfortable position. Ensure the comfort of patient.
24 Replace articles in proper place, record the treatment with date, time, amount of solution used, character of return flow and condition of patient before, during and after the procedure. Provides detail information's about the procedure.
25 Continue to monitor the patient every 25-30 minutes as dictated by his/her condition. Helps to identify the complication.

 

Use of Bed Pans and Urinals

Bedpans and urinals are devices that allow people to have a bowel movement or urinate while they are in bed. A client may need to use a bedpan or urinal because he cannot walk to the bathroom. He may have an illness, injury, or surgery that makes him unable to walk. A person should regularly urinate and have bowel movements to help prevent other health problems from occurring. There are several different kinds of bedpans and urinals available. Some are metal and others are hard plastic.

Purposes:

  • To facilitate bowel and bladder elimination in a bedridden patient.
  • To collect specimen.
  • To perform bowel and bladder training.

Supplies:

  • A basin with warm water
  • Disposable gloves
  • Specimen container.
  • Soap/Towels
  • Wash cloths or wet wipes / toilet paper.
  • Bedpan,
  • Toilet paper or wet wipes
  • Makintosh

Procedure

S.N. Nursing Action Rationale
1 Explain the procedure. Reduces anxiety and promotes cooperation.
2 Assess client's normal bowel elimination habits, routine pattern and normal fluid intake. Provides baseline information.
3 Assess client's level of mobility, amount of assistance required. Determines the type of bedpan to be used and helps in identifying the level of assistance required from the nurse.
4 Provide privacy. Remove top linen just enough, so they are out of the way. But do not unduly expose patient. Reduces embarrassment and promotes client's dignity.
5 Wash hands and wear gloves. Reduces transmission of microorganisms.
6 Gather the equipment. Aids for smooth functions.
7 Place a waterproof pad under the person's buttocks. Protects bed linen from spills.
8 Warm bedpan with warm water if available and dry it. Promotes comfort and warm bed pan helps to relax anal sphincter.
9 Position bed to convenient height. Ensures good body mechanics.
10 Elevate side rails on opposite side. Reduces risk of accidental fails.
11 Raise the head of the bed a little if it is allowed. Sitting upright makes more natural position and having a bowel movement or urinating easier.
12

In patient who can move lower limbs, ask patient to flex knees, resting the weight on back or legs and then raise the buttocks with the help of a trapeze if available.

If patient is not able to move, obtain assistance from another nurse to lift the patient onto the bed pan.

Or

Roll the person on his side. Place the bedpan against the buttocks of the person with one hand.

While holding the bedpan in place, gently roll the person onto his back and up onto the bedpan.

 These movements will allow  patient to support some of his/her body weight him/herself.
13 Place a regular bedpan under patient with the smooth rounded rim under the patient's buttocks. Ensures client's comfort.
14 Cover patient with bed linen and leave client alone if possible. Give the person privacy if possible. If he is weak, do not leave him alone. Promotes the dignity of the patient.
15 When removing bed pan, lower the head of the bed and return bed to the position used when giving bedpan. Increases client's ability to move to side lying position.
16 Hold bedpan with one hand steady, remove it, or roll the person on his side. Prevents possible spillage.
17 Cover the bedpan and place it away. Prevents from unpleasant odor to the unit.
18

After he uses the bedpan, gently roll the person on his side.

Clean the buttocks of the person with toilet paper, his side. wet washcloth or wet wipe to clean the area. If necessary, use soap and water to clean the area well.

If the person is a female, clean from front to back. 

If client can help by him/herself, provide tissue to wipe.

Dry the area between the person's legs.

 Wiping from front to back decreases chances of cross contamination from the anus to the urethra.
19 heck the skin for redness or sores. Ensures the conditions of skin.
20

Use of urinal

Put on disposable gloves.

Ask the person to put the urinal between his legs. Spread the person's legs if he cannot do it himself.

If the person is male and needs extra help, place his penis into the opening at the top of the urinal.

Position the urinal and hold it gently while the person urinates.

When the person is done, carefully remove the urinal.

Gently wipe between the person's legs with a damp washcloth. If the person is a female, clean from front to back.

Dry the area between the person's legs.

Measure the urine output if necessary.

  
21 Take the bedpan or urinal to the bathroom and empty it into the toilet. Ensures proper disposal.
22 Clean the bedpan or urinal with a disinfectant soap or cleaning solution such as bleach. Prevents from cross contamination.
23 Remove gloves and wash hands. Prevents transmission of microorganisms.
24 Position client comfortably. Ensures client's comfort.
25 Record the procedure. Provides data and communicate information to others.

 

Maintaining Intake and Output Chart

Fluid intake and output means fluid intake equal to fluid loss. Intake is any measurable fluid that goes into the client's body. It includes fluids such as water, soup, fruit juice etc. solids composed primarily of liquids such as ice cream, gelatin, that are taken mouth, fluids that are introduced by intra venous route and fluids that are introduced by tube. Output is any measurable fluid that comes from the body such as urine, drainage, vomits, and watery stools.

In certain condition e.g. unconscious patient, surgery of gastrointestinal tract, kidney and cardiac disease, etc. balance is disturbed. This is maintained by an intake and output chart. The main fluid in body is water. Total body water is 60% of body weight. Input of water is regulated mainly through ingested fluids which in turns depends on thrust. The body's homeostatic control mechanisms, which maintain a constant internal environment, ensure that a balance between fluid gain and fluid loss is maintained. The hormones ADH and Aldosterone play a major role in this.

Purposes

  • To judge the condition of the patient.
  • The monitor the fluid and electrolyte balance.
  • To assess the fluid requirement.
  • To determine the treatment.

Patients who need intake and output charting are:

  • Unconscious patient.
  • Patients with diarrhoea and vomiting.
  • Patient with kidney and heart disease.
  • Patient with burns.
  • Patients taking diuretic drugs.
  • Pre-operative/pos-operative patients. (Particularly after surgery of urinary tract and gastrointestinal tract).
  • Patient with tube feeding, liquid diet, NPO, I/V fluids, etc.

Equipment

  • Intake/output chart
  • Measuring glass to drink fluid
  • Jug, bed pan, urinal
  • Gloves
  • Syringes (20 ml, 50 ml, etc.) for NG tube aspiration.

Procedure to record intake

  • Check the physician's instruction.
  • Explain the patient and patient party about the importance of maintaining I/O chart.
  • Prepare the required equipment and carry them all to the patient's bed side.
  • Prepare the fluid to be given orally e.g. tea, fruit juice, milk, glucose water, etc.
  • Prepare the IV fluid or tube feeding as advised by the doctor.
  • Measures the amount accurately. If a feeding cup is used, measure the capacity of the feeding cup.
  • If the patient's own container is used measures the capacity of the container and mark accurately with an adhesive tape.
  • Keep the measuring glass near the patient's bed side.
  • Record and report date, time, amount, type of fluid, total intake and output for a fluid. Total intake and output for 24 hrs is calculated in the morning by the nurse on night duty.

Procedure to record output

  • Wear disposable gloves to prevent contact with micro-organisms or blood in urine and drainage bag or bottle.
  • Ask the client to void in a urinal or bed pan of aspiration or vomits.
  • Pour the voided urine into a celebrated container or an empty I/V bottle.
  • After measuring urine from a client who has an indwelling catheter, place the container under the urine collection bag so that the spout of the bag is above the container but of you touching it open the spout and permit the urine to flow into the container. Close the spout.
  • Holding the container at eye level, read the amount in the container. Discard the urine in the toilet.
  • If nasogastric tube for aspiration, measure the aspiration fluid and record.
  • Remove gloves and wash hands.
  • Record the amount of output each time of the patient's urinals or aspiration by nasogastric tube or vomit in intake output chart.
  • In the patient vomits into basin or has diarrhoea in bed pan, you should measure them the same as urine.
  • Rinse bed pan or urinal, measuring jug and return the proper place.
  • Drainage tube.

Points to remember

  • Intake oral fluid, intravenous fluid, tube feeding and output (emesis, diarrhoea, urine suction aspiration, drainage) must be measured carefully and recorded in the appropriate columns on the I/O chart of the patient.
  • If the patient passes urine in the bed, estimate the amount of urine passed in ml and make comment on the chart (bed wet).
  • Intake output records only the amount of fluid taken. If the patient takes solid food, record in comment column.
  • Many clients can measure and record their own urine output, when it is explained to them.

 

 

 

 

 

 

 
Things to remember

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