Gastric Lavage

1

• Gastric Lavage
• In
• The diagnosis of tuberculosis in young children

2
Gastric lavage

• Gastric lavage is the standard method of
  obtaining specimens for TB diagnosis in young
  children.
• It is generally carried out only in infants and
  children below the age of two years.
• In older children specimens for TB microscopy and
  culture are better obtained by sputum induction,
  or voluntary coughing.

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It is best to perform the lavage first thing in
the morning before the child has had food or
drink.
4
The procedure

• First explain the procedure fully to the parent
  or caregiver.

5
The procedure (continued)

• Place the infant or young child in the supine
  position, and have an assistant restrain the
  child and flex the head slightly.

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The procedure (continued)

• Select the appropriate tube. Determine the
  length to be passed by measuring the distance for
  the manubrium sterni to the xiphisternum. Double
  this and add 5cm. Mark the appropriate length on
  the tube.

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The procedure (continued)

• Lubricate the lower 3-4cm with KY jelly, and pass
  it through a nostril toward the occiput (not
  vertex). If resistance is encountered, withdraw
  the tube and try the other nostril. Continue
  even if gagging occurs but withdraw immediately
  if there is severe coughing, choking or cyanosis.

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The procedure (continued)

• Introduce the selected length and fix the tube
  lightly to the cheek. Aspirate the tube and test
  the contents with litmus (blue to red indicates
  acid). If no fluid is obtained advance the tube
  3cm and try again. If still unsuccessful, inject
  3m of normal saline. Withdraw the tube if this
  causes coughing.

9
The procedure (continued)

• Using a syringe, draw sterile 0.9 NaCl for
  lavage from a 20ml ampoule 5 10 mls for babies
  less than 1 year and 10-20 mls for babies older
  than 1 year. Inject NaCl into the stomach through
  the tube and leave for 2-3mins.

10
The procedure (continued)

• Withdraw a volume equal to that of the normal
  saline injected and collect into a 50 ml tube
  containing 100mg of sodium bicarbonate.

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What to do with the specimen

• Screw the cap tightly closed.
• Invert the tube 5 times to mix contents.
• Label the jar with the aspirate as follows 
• Child's name
• Name of hospital
• Place a patient identification sticker on the
  jar, with the number (1 or 2) and type of
  specimen(i.e. gastric lavage)
• Date and time of collection.
• Complete a request form for the laboratory and
  place a patient identification sticker on this
  form.
• Place the specimen in a plastic bag together with
  the request form, and keep in the ward
  refrigerator (NOT freezer) or in a cooler box
  containing ice packs.

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What to do with the specimen

• Transport specimens to the laboratory as soon as
  possible after collection, but in any case within
  a maximum of 4 hours
• Specimens should be placed in a closed 3kPa screw
  cap transport container containing sufficient
  absorbent material to absorb any potential
  spillage. 
• The 3kPa container should then be placed in a
  secondary transport box containing an ice pack.
  This box must be clearly labeled as biohazardous
  and containing potentially infectious material.

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What then?

• Then give the usual milk feed

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What then?

• Obtain two specimens per patient (on consecutive
  days).
• Specimens should not be collected over weekends
  unless unavoidable, in which case they will be
  placed in the refrigerator whilst awaiting
  collection

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Safety issues

• Since insertion of the nasogastic tube may induce
  coughing, there is a possibility that M.
  tuberculosis aerosols may be generated.
• Staff present in the ward should wear N95
  respirator masks throughout the procedure.
• All potentially contaminated devices should be
  discarded or sterilized before re-use.