The LSUHSC New Orleans
Emergency Medicine Interest Group
The Student Procedure Manual
by Rodd Daigle with
- Accidental or intentional poisonings
- Ingestion of nontoxic or insignificant amounts of toxic substances
- Possible ingestion of strong alkalis
- Ingestion of hydrocarbons
- NEVER needlessly endanger yourself in order to care for a patient. If the patient
is intoxicated, make sure that you have adequate assistance and/or medical immobilization
so that you may perform this procedure safely.
- ALWAYS gown, mask (with eye protection)
and glove. I would recommend shoe covers if they are available and you value
- Large diameter rubber gastric hose (32 - 50 French). See Figure 1.
- block or elliptical endoscopy bite block (if intubation is to be oral)
- Lubricating or local anesthetic jelly (if inserting a nasogastric tube)
- 50 ml catheter tipped syringe
- Y connector and clamp
- Cuffed endotracheal (ET) tube
- 3 L tap water
- Activated charcoal (1 gm/kg) with Sorbitol (25 mg/kg)
- Note: ready - made lavage kits are often available
- Gown, mask (with eye protection) and gloves should ALWAYS be worn.
- Detennine level of consciousness (LOC), if the patient has a decreased
LOC then his airway-protective reflexes will be decreased, and aspiration
of gastric contents into lungs is likely. If there is doubt, check for
a gag reflex. If gag reflex is absent, or the Glasgow Coma Scale(GCS) is <
- If the patient doesn't blink reflexively after touching the eyelashes, probably
there is an impaired neuro exam and an unprotected airway, requiring a cuffed
- Place patient in the left lateral decubitus position with the head
lowered about 10' (this decreases the passage of gastric contents into the
duodenum during lavage, and reduces the possibility of pulmonary aspiration
of gastric contents.
- Restrain the uncooperative patient's hands.
- Estimate tube length; it should stretch from the nose, around the ear
and to the midepigastrum.
- Tubes of 36 French or larger should be passed orally.
- If performing nasogastric incubation, lubricate tubing with jelly.
- Have patient put his chin on his chest to facilitate entrance of tubing into
- Gently push tubing through nose or mouth.
- Confirm tube's entrance into the stomach by auscultation over the gastric region
while injecting air with the 50-ml catheter tipped syringe.
- Carefully aspirate gastric contents, repositioning the lavage tube often.
- Tape the lavage tube in place.
- Administer tap water using the Y connector and clamping the drainage arm of
the lavage tube.
- Administer several aliquots of about 200 ml for adults and 10 ml/kg for children,
draining after each infusion.
- Continue lavage for 3 L after gastric returns are clear.
- Activated charcoal (I gm/kg) is then introduced through the ravage tube.
- Clamp the lavage tube, to avoid drippina fluid into the trachea, and gently
- If repetitive doses of activated charcoal are to be administered, the lavage
tube should be removed and a standard nasogastric tube should be inserted.
- Serious esophageal injury or perforation in cases of strong alkali ingestion.
- Pulmonary aspiration of gastric contents.
- Kinking of lavage tubing.
- Inadvertent tracheal incubation.
- Nasal mucosal and turbinate injury.
- Severe dilutional hyponatremia in children ravaged with tap water.
- Washing of gastric contents into duodenum.
- Mucosal injury or perforation of the stomach or lower esophagus
- Hypothermia due to cold lavage fluid.
Interpretation of Results
- When return lavage fluid does not clear, it is recommended to continue to lavage
for at least an additional 3 L.
- Clear return fluids indicate that lavage was probably
- Activated charcoal (I gm/kg) is normally administered following lavage. A cathartic
(sorbitol) may be added although the utility has not been demonstrated.
- There are some experts who recommend pushing a bolus of activated
charcoal FIRST, BEFORE you begin aspirating gastric contents. It is thought
that the charcoal is useful in this way due to the reflexive gastric emptying
that occurs upon ravage. This way the charcoal gets pushed along with the
ingestant (to absorb and deactivate it) as the ingestant get pushed into the
- Whole bowel irrigation. This is used in patients such as drug packers and
those with sustained release tablet poisonings (such as iron, antihypertensives
and some NSAIDS).
- Repetitive dose charcoal, multidose activated charcoal (MDAC)-Tylenol, aspirin,
dilantin, theophylline, phenobarbital, and tricyclic antidepressants
- Ipecac-induced emesis. Rarely indicated. Absolutely contraindicated in caustic
or hydrocarbon ingestion.
This page copyright © 1997-2002 LSUHSC EMIG. All rights reserved.