Gastric Lavage for Removal of Toxic Substance

1.  Verify the patient's identity in accordance with institutional policy.
2.  Verify that informed consent has been obtained (not applicable in emergency situations).
3.  If possible, determine agent and amount ingested and the length of time since ingestion.
4.  Perform hand hygiene and don clean gloves, gown, and goggles.
5.  Assess airway patency and provide breathing support (and remove dental appliances). The physician or advanced practice nurse performs endotracheal intubation if there is no airway patency. Have suction equipment available.
6.  Assess circulation and obtain venous access with an IV infusion of a crystalloid solution (normal saline or Ringer's lactate).
7.  Perform a neurologic assessment.
8.  Obtain vital signs and oxygen saturation via pulse oximetry and place the patient on a cardiac monitor.
9.  Assess for a gag reflex (if patient is not already intubated).
10. Restrain the patient as indicated and prescribed per institutional policy.
11. Place the patient in the left lateral decubitus position with the bed in the Trendelenburg position.
12. Assemble the lavage tubing and prime the tubing with fluid.
13. Insert a large-bore orogastric tube and verify tube placement. Place a bite block to keep the patient from biting the tube.
        a. Use a 60-ml syringe and aspirate gastric contents, saving the initial sample for a toxicology screen; assess the appearance of the aspirate. Gastric contents may be cloudy, grassy green, straw, tan, brown, clear, or off-white.  
        b. Detect ETCO2 using a capnometer or a colorimetric ETCO2 detector.
        c. Verify placement of tube via chest radiograph when patient is at risk for malposition of the tube or other methods are inconclusive.
14. Unclamp the tubing between the fluid bag and the patient, and instill 200-300 ml of warmed fluid. Then reclamp the tubing.
15. Unclamp the tubing between the patient and the drainage source, and allow the fluid to drain into the bucket by use of gravity. If no fluid returns, use the syringe to pull the fluid and the particles gently through the tube. A small position change of the patient may assist with fluid return. Keep a running tally of the fluid input and output.
16. Repeat steps 14 and 15 until the fluid return is clear of stomach contents. If no gastric contents return, it is likely that the substance is in the small intestine or that large pill fragments are present and cannot traverse the tube.
17. If prescribed, instill activated charcoal before removing the lavage tube.
18. With suction available, remove the tube while the patient is in left lateral decubitus position.
19. Observe for vomiting.
20. Monitor airway, breathing, circulation, and level of consciousness.
21. Discard supplies, remove gloves, and perform hand hygiene.
22. Document the procedure in the patient's record.