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Fluids & Electrolytes
NASOGASTRIC (NG) OR OROGASTRIC LAVAGE, typically performed by the healthcare provider or nurse in the ED or ICU, is usually indicated for patients with upper gastrointestinal (GI) bleeding. A bloody lavage can be helpful in diagnosis, particularly in hemodynamically stable patients without hematemesis. Gastric lavage can also be helpful during upper endoscopy by clearing blood and other gastric contents to aid visualization. Remember, however, that a negative lavage doesn't exclude upper GI bleeding; it's associated with a false-negative rate of about 10%. In these patients, the bleeding may be intermittent or located in the duodenum.
Before the procedure, assess and document the patient's level of consciousness (LOC) and obtain and record vital signs. Assess for and document any contraindications to gastric lavage, such as decreased LOC with an unprotected airway. Document patient teaching provided.
Record the date and time of lavage, the size and type of gastric tube used, the method used to verify correct tube placement, the volume and type of lavage fluid instilled, and the volume of lavage fluid returned, including its characteristics such as color.
Continue to frequently assess and record LOC and vital signs until the patient is stable. Note the time that the tube was removed and how the patient tolerated the procedure. A good note might look like this:
Chart Smart: The A-to-Z Guide to Better Nursing Documentation. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins;2007:156-158.
Khilnani N, Hussain N. Gastrointestinal bleeding. Emerg Med. 2005;37(10):27-32.
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