Name: _______________________________________ Date: ___________________
Year & Section : _______________________________
PROCEDURE CHECKLIST FOR GASTRIC LAVAGE
NCM 112 SL
Legend: Done Student performs consistently in an effective and efficient manner
Not Done No progress in performance has been demonstrated and/or
Performance is consistently ineffective and inefficient
Procedure Don Not Done Remarks
e
1. Verify Doctors order.
2. Gather equipment
Nasogastric insertion equipment
Lavage fluid – Nacl or
other prescribed solution
Syringe 20ml for aspiration and
50ml for lavage/ asepto syringe
Specimen container with lab request form
Kidney dish as receiver.
Stethoscope
Measuring jug
Protective sheet
Clinical waste
Domestic waste
3. Perform hand hygiene. Put on gloves.
4. Asses patient level of consciousness
5. Confirm patient identity using 2 identifiers
6. Greet patient and explain procedure
7. Provide privacy
8. Remove dental appliances and inspect oral cavity for loose teeth
9. Position patient in Semi-Fowler’s or Fowler’s or sitting position (if contraindicated,
slightly elevates patient to right side-lying position).
10. Insert NG tube as per procedure handout
11. Places towel over the chest area. Has kidney basin at hand in case patient vomits.
(If infant, provides a pacifier if available).
12. Pinches or clamps the tubing. Opens the free end of the tubing.
13. Attach the end of the asepto or bulb syringe to the NGT tube.
14. Determine the patency and placement of the NGT by:
a. Gently introduce a little air into the tube using the bulb or asepto syringe and
auscultate for a gurgling sound with the stethoscope on the epigastric area.
b. Aspirate stomach contents by applying negative pressure using the bulb
or plunger of the asepto syringe.
15. Repinches or clamp the tubing and measures the amount of stomach content. Keep
specimen in container for analysis.
16. Removes the bulb or the plunger, returns aspirated stomach contents. Releases
pinch or clamp from the tubing to let aspirated stomach contents to flow by gravity.
Note: If more than half the last feeding or irrigation is withdrawn or with coffee
ground aspirate, refer.
17. Pinches proximal end of the tube and instills about 50 ml of normal saline solution
(amount and temperature vary upon doctor’s order) into the syringe barrel
18. Pinches the proximal end of the tube when the barrel empties
19. Connect the bulb or plunger of the syringe using negative pressure to slowly
aspirate the normal saline solution
20. Removes the asepto syringe from the tip of the tube then discards the aspirated
content in the kidney basin or measuring container (checks to see that the amount
drained, equals/approximates amount instilled)
21. Repeat step 17-20 until returns are clear. Usually requires a total volume of 2 liters.
22. Record input and output throughout procedures
23.Remove NG tube as per procedure handout or clamp end of tube. Remove the
asepto or bulb syringe.
24. Closes and secures tubing. Removes towel and kidney basin.
25. Instructs client to remain in upright position for 30-60 minutes.
26. Make patient comfortable
27.Label specimens and dispatch to lab immediately
28.Clean and clear equipment. Remove gloves.
29. Perform Hand hygiene
30.Record and report findings
• Type, color and consistency of the drained gastric contents, intake and output,
client’s tolerance/response to the procedure.
31. Monitor for breath sounds, bowel sounds, gastric distention, diarrhea /constipation,
intake and output, daily weight and laboratory results. Check vital signs urine output,
level of consciousness
__________________________ _______________________________________
Signature of Students Name and Signature of Clinical Instructor
