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Gastric Intubation, Gavage, Lavage 1117

Gastric Intubation, Gavage, Lavage
VetBooks.ir

• If even one of these conditions is present,
Difficulty level: ♦♦
in pneumomediastinum, pneumothorax,
the risk of the procedure versus its benefits ○ Tracheal or bronchial tearing can result
Synonyms (which will vary from case to case) must and death.
Gastric decompression, orogastric feeding, be considered before deciding whether to ○ Tracheal or bronchial administration of
orogastric intubation perform the procedure. gavage or lavage fluids can result in severe
aspiration pneumonia and death.
Overview and Goals Equipment, Anesthesia ○ The procedure (as explained below)
Passage of a hollow tube into the mouth and Gastric intubation: describes avoidance of these complications.
through the oropharynx into the stomach to • Two assistants (minimum) • Oral, pharyngeal, laryngeal, esophageal, or
facilitate decompression of gas, removal of stomach • Flexible plastic tubing of various lengths gastric trauma can result if excessive force
contents (lavage), or administration of large and diameters. The distal end must be is used for passing the gastric tube. Full- Procedures and Techniques
volumes of liquid, food, or medication (gavage) smooth and atraumatic; smoothing may be thickness tearing is possible, especially with
achieved by brief heating of the end of the a pre-existing underlying disease.
Indications tube over a flame, cooling, and trimming • Inability to pass the tube into the stomach
• Gastric intubation edges with a scalpel blade. One to three side may reflect the choice of a tube with a diam-
○ Preoperative stabilization of gastric dilation/ holes may facilitate evacuation of stomach eter that is too large, esophageal obstruction
volvulus (GDV); allows evacuation of contents by minimizing obstruction of a (foreign body, stricture, neoplasia), torsion of
gas and fluid, resulting in an improved single distal hole with gastric mucosa or the stomach, or excessive lower esophageal
hemodynamic state ingesta. sphincter (LES) tone. Discontinuation
○ Relief of discomfort associated with • A roll of clinic-type white cloth tape of metoclopramide before elective gastric
gaseous dilation (without torsion) of the • Water-soluble lubrication jelly intubation is recommended to minimize
stomach • Mouth gag/speculum LES tone.
• Gavage If gastric lavage, all of the above plus • Inadequate sedation of an uncooperative
○ Administration of large volumes of liquid • Funnel or stomach pump animal will lead to longer procedure times
medication, including • Container (e.g., bucket) to collect stomach and increased risk of injury to the animal
Activated charcoal after toxin ingestion contents and lavage fluid and veterinary staff.
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(p. 1087) • Lavage fluid: usually warm (body tempera- • Inability to effectively remove gastric contents
Barium for gastrointestinal (GI) contrast ture) water through lavage may be related to excessive size
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radiography (p. 1172) or adhesive nature of gastric contents, gastric
Hyperosmotic laxative agent before Anticipated Time compartmentalization, or other factors.
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colonoscopy Depends on cooperation of animal; additional • Regurgitation during lavage, gastric overfill-
○ Administration of formula to neonatal time may be needed for sedation or general ing, or esophageal administration of large
animals that are not nursing on their own anesthesia volumes of lavage fluid can result in aspira-
• Lavage • Gastric intubation: 2-5 minutes tion if a cuffed ET tube is not in place.
○ Removal of stomach contents with • Gavage: 3-10 minutes • Excessive tube advancement can cause
suspected intoxications • Lavage: 10-60 minutes occlusion of the distal end of the tube
○ NOTE: Gastric lavage may not be indicated against stomach mucosa. Palpation of the
in all cases of toxin ingestion. Substance Preparation: Important tube pressing against the stomach wall may
ingested, consistency, time since ingestion, Checkpoints indicate a need for partial retraction.
and animal status influence whether gastric • Ensure that adequate manual or chemi-
lavage is appropriate. cal restraint for the procedure is planned. Procedure
• Preoperative stabilization of GDV (p. 377). Personal preference and animal stability • Manual restraint, sedation, or general
Removal of stomach contents may help decrease may dictate the degree of sedation or anesthesia as indicated
the speed of gas reaccumulation while the anesthesia chosen. NOTE: Some clinicians • Position animal in sternal recumbency. If
animal is being prepared for surgery, slowing prefer to ensure a patent and protected animal is uncomfortable, alternate positions
or preventing cardiovascular deterioration. airway to minimize the potential for (e.g., sitting, standing, lateral) may be better
aspiration pneumonia through the use tolerated.
Contraindications of general anesthesia and a cuffed endo- ○ Placement of the animal on an elevated
• Esophageal disease may lead to tube-induced tracheal (ET) tube when gastric lavage is surface will allow gravity-assisted efflux of
trauma or perforation. Conditions of concern performed. stomach contents and lavage fluid after
include esophageal stricture (p. 310), neo- • Maximize cardiovascular stability before the the tube is in place.
plasia, ulceration, megaesophagus (p. 642), procedure. • Choose appropriate tube diameter for
and recent esophageal surgery. esophageal size and procedure planned. For
• Gastric disease may lead to tube-induced Possible Complications and example, a tube with an outer diameter of
trauma or perforation. Conditions of concern Common Errors to Avoid 1.5 inches (3.5 cm) is appropriate for most
include neoplasia (p. 379), ulceration (p. • Inadvertent passage of the orogastric tube medium-sized dogs (45 lb [20 kg]). A larger
380), and recent gastric surgery. into the trachea can result in mild to severe tube size may be necessary to facilitate effec-
• Any swallowing disorder (e.g., megaesopha- complications. tive lavage compared to gas decompression
gus, esophageal motility disorder), pharyngeal ○ Tracheal irritation leading to transient only.
disorder, or laryngeal disorder (e.g., paralysis coughing or mucosal bleeding is possible. • Measure the length of tube necessary to pass
[p. 574], previous tie-back surgery) that could ○ Tracheal or bronchial placement of the from the nose to the xiphoid. Mark this
predispose a non-endotracheally intubated gastric tube can result in airway obstruc- distance on the tube with a piece of tape
animal to aspiration tion until the tube is repositioned. or nontoxic marker.

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