Nursing Practical Guideline Procedure : Stomach Wash-Out

Stomach Wash-Out

Washing out the stomach is a procedure that may be ordered in cases of pyloric stenosis in intestinal obstruction immediately before operation, and in the treatment for poisoning when the poison has been swallowed particularly in cases of narcotic poisoning or acute alcoholic poisoning. A stomach wash-out may be given in the treatment of poisoning by a corrosive or caustic substance after the poison has been neutralized.

Requirements :

1.     Jacques' asphageal catheter, for an adult sizes 18 to 20, for a child sizes 8 to 14, and for an infant a soft rubber catheter, size 8.

2.     A glass connection.

3.     A length of rubber tubing (3 to 4 feet)

a.     A large glass funnel.

4.     Large jug containing the solution for the wash-out.

5.     This, sodium bicarbonate 1 drachm to water 1 pint, or normal saline 6 pints, should be prepared at a temperature of 100^o F.

6.     A pint measure.

7.     A large pail to receive the wash-out.

8.     A receiver for tube after use.

9.     A mouth wash and a few small squares of old linen.

10.                        A lubricant, such as glycerin or butter, may be required.

11.                        A mackintosh to protect the bedclothes and a mackintosh cape to protect the patient' s grown.

12.                        A gag will be required if the patient is unconscious.

Method :

1.     The apparatus should be placed in a bowl of hot water.

2.     The pail stands on the floor at the bedside and should be placed on newspaper to protect the floor.

3.     If the patient is conscious and able to co-operate, the usual position is sitting upright leaning slightly forward

4.     if he is unconscious, the usual procedure is to have him prone, with the head over the edge of the bed or couch, or else on his back with the head lower than the body.

5.     The tube should be marked at 16 and 18 inches.

6.     The tube is easier to swallow if it has been chilled on ice before use.

7.     The tube should be passed over the tongue slightly to one side of the midline towards the pharynx and the patient if conscious, is directed to swallow, the tube being pushed along as he does so.

8.     He should be allowed time to breathe and directed to take a fairly big breath between swallowing.

9.     The average distance from the lips to the cardiac orifice of the stomach is 16 inches, so that when 18 inches of the tube have been swallowed it is safety in the stomach.

10.                        The pint measure is filled with solution from the large jug and about 1 pint is allowed to flow in.

11.                        When the funnel is almost empty, it should be inverted over the pail and the fluid siphoned back.

12.                        The process is repeated until the fluid is returned clear or until the prescribed amount of the solution has been used.

13.                        The tube should then be tightly compressed and with-drawn quickly.

14.                        The patient should be given the mouth wash and the pieces of old linen to wipe his mouth.

15.                        The contents of the pail should be measured and saved for inspection. Several gallons of fluid may be needed to wash out the stomach in cases of poisoning.

16.                        If unconscious the patient is placed in either the prone or Trendelenberg' s position to prevent fluid running into the air passages.

17.                        The lavage in these cases is performed by the doctor.

18.                        Aspiration of stomach contents for diagnostic purposes or to empty the stomach as in acute gastric dilatation or paralytic ileus is usually carried out by means of a Ryle' s tube, a small asophageal catheter (size 6) or a Miller-Abbott' s tube passed through the nose and left in position.

19.                        The lubricated tube is passed along the floor of the nose until it reaches the pharynx.

20.                        The patient may then be given sips of water and the tube is pushed on by the operator while the movements of swallowing are taking place.

21.                        The stomach contents are removed by a syringe attached to the end of the tube or by continuous suction using a siphonage apparatus.

22.                        A simple siphonage apparatus may be set up using a large bottle containing water which is suspended neck downwards, about three feet above the level of the patient' s body.

23.                        The bottle is closed with a two-hole rubber bung through which pass one short and one long piece of glass tubing. The short tube is connected by a length of rubber tubing to a similar bottle standing on the floor and the rate of flow water from the upper to the lower bottle is controlled by a screw tubing clip. The longer piece of glass tubing which projects beyond the water level in the suspended bottle is connected to the Ryle' s or Miller-Abbott' s tube.