GI Decontamination Lite (Revised 15DEC09)[1]

8/8/2019 GI Decontamination Lite (Revised 15DEC09)[1]

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GI Decontamination

GI Decontamination

Two question:Is GI Decontamination indicated? Any Jetso

What method?

Method of GI decontamination:

1. Single dose of activated charcoal

2. Gastric lavage

3. Multiple dose of activated charcoal (MDAC)

4. Whole bowel irrigation

5. Surgical intervention

Activated Charcoal

Black power prepared by burning of carbonaceous, activated mean

increase surface area (in 50 gm of Activated Charcoal, the surface area ~

10 football Court) Toxic absorb (actually stick on the surface of

activated charcoal)

CHARCOAL Some toxin are not well absorb by activated charcoalCorrosive/ Caustic

Heavy Metal (Iron, Lead, Lithium)

Alcohol

Rapid Onset (Cyanide)

Chloride, Iodine

Other insoluble in water

Aliphatic hydrocarbon (petroleum distillate)

Laxatives (Na, Mg, K)

Dose:

Adult: 50 100 gram / Children: 1gm/ kg

UCH preparation

Adult: 50gm AC + 75ml 75% Sorbitol & top up with 400ml H20

Children: 50 gm Carbsorb + 75ml 75% Sorbitol & top up with 400ml H20

(1gm/kg = 8ml / kg)


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Multiple dose of activated charcoal (MDAC)

For decrease ongoing absorption (sustained release or form concretions

in GI tract) such as Phenobarbital, theophylline, dogitoxin, phenytoin

Enhance elimination: reduce enterohepatic recirculation and gut dialysis

Dose:

After initial single dose of AC, MDAC 0.5gm/kg Q2H-Q4H X 4 doses

Contraindication:

Absent bowel movement/ perforated / Endoscope predicted view the

injury site by caustic/ Loss gag reflexes

Caution:

Always check the activated charcoal with/without cathartic, MDACcannot use cathartic to prevent electrolyte imbalance

Complication:

Fatal Aspiration, Pneumonitis, Small Bowel Obstruction, Appendicitis

Gastric Lavage

Gastric Lavage mean use large-bore tube to lavage stomach, different to

use small bore NG tube to empty stomach

(Adult 36 40 Fr, Paed Not smaller than 22-24 Fr), (prefer intubatedthe patient to protect the airway)

Tube is round end firm to pass stomach & soft to minimize trauma

Indication:

Acute life-threatening toxin ingested likely still present in stomach

preferred within one hour (more than one hour is NOT contraindicated)

Contraindication

Caustic ingestion

Large FB or sharp object

Absent gag reflex without intubation

Complication

Aspiration pneumonia

Esophageal / Gastric perforation

Tension pneumonthrox / Emphyema

O2 Desaturation


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Procedure:

Before gastric lavage, we need prepare:

Functional suction must available

Awake patient: get consent and cooperation

Protect airway if needed: intubated patient with bite block

How to use the Easi-Lav SystemSetup

Clamped both fluid and waste bag, hang the fluid bag with IV stand

and put the waste bag in a bucket

Fill the fluid bag (Adult with water/ N.S., paed with N.S. prefer with

warm fluid)

Advance both syringe in forward position (release the syringe) Attach BLUE tubing in BLUE input (fluid) port & RED tubing in RED

output (Waste) port

Keep the BLUE input plunger in forward position; otherwise fluid will

flow into the patient.

Measure, insert & and confirm (50ml Syringe) the Lavage tube

Position patient in Lt. lateral head down position

Attach syringe to lavage tube & pinch collar in place

Induce the Mechanism of the EASI-LAV System

Lock the RED output pushing the plunger completely forward androtated 90 degree clockwise..

Prime the system by gently pump the BLUE plunger 3 times to

partially fill the stomach (Adult 200-300 ml H2O / Child 10ml / kg

N.S. prefer warm)

Unlock the Red Output plunger by rotated 90 degree counter-

clockwise.

Unlock all clamps; grasp both plunger handle and push forward and

backward for start stomach lavage.

Never pull output plunger forcefully to avoid mucosal damage. Keep first aspirate for toxicology test

Lavage adequate volume until clear.

Charcoal

Lock the RED plunger, attach the Char-FLO tube to BLUE Port or

pour in fluid bag and add 50-75 ml fluid to speed up administration.

Disconnect the lavage tube and direct administrate charcoal (pre-

packed) into lavage tube


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Whole Bowel Irrigation Mechanical cleansing of GI tract by large volume of isotonic iso-

osmotic fluid (Golytely/Klean Prep )

Marcogol passes thro the gut without absorbed into body & with e+ It produce rapid catharsis and safely in small children esp. for toxin

not well adsorbed to charcoal (iron, lead, lithium. Zinc) & sustained

release product but not a substitute of AC

For body-packers / body-stuffers.

Contraindication:

Absent bowel sound

Bowel obstruction / perforation

Dose:

1 pack Klean prep mixed with 1 Liter water

Adult: 1-2 liters/ hour & Child: 0.5 liter / hour

By oral or NG tube (preferred)

Until rectal effluent is clear

Complication:

Vomiting / boating frequently occur Rectal irritation

Adjuncts:

Antimetics (Maxalon)

Promotility agent (speed digestion) - Erythromycin

Pit fall:

WBI solution will occupy AC binding sites, means it may help to

release the already absorbed toxin from AC and potential increasetoxicity


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Trouble-Shooting (Not in Lecture)

Symptom Cause Solution

Blue Plunger cannotpull back

Fluid bag clamped Unlock the clamp

Blue Plunger cannot

pull forward

Gastric tube clamped Unlock the clamp

Resistant on RED

output plunger pull

back

1 Gastric tube

locked

2 Gastric mucosa

obstruct the

tube end

3 Forward valve

blocked by

debris

4 Gastric tube end

blocked by

debris

5 Unlock the clamp

6 Reposition the

tube and

withdraw

7 Lock the RED

plunger and

inject lavage

fluid through

BLUE input port

8 Clamp the

Gastric tube and

UNLOCK the

RED output

plunger, forcefulpush BLUE input

port to flush

through RED

output plunger

9 Open gastric

clamp and lock

the RED output

plunger, then

pump the blueinput plunger


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RED input plunger

cannot push forward

1 Waste bag

clamped

2 RED output value

obstructed

3 Lock gastric

clamp

4 Lock gastric

clamp, unlock

RED plunger andpump the BLUE

plunger to clean

debris

5 Open gastric cla

mp

Cannot push the plun

gers

Plungers adhered Forcefully push & pull

the plungers

RED output plunger jammed

Plunger out ofgrooves track

1 Lining up thetracking rib with

the grooves

2 Push plunger

forward until a

snapping sound

heard

Waste bag tube pops

off

Port surface slippery Clean the port & tube

with alcohol swab

Gastric tube pops off

the syringe tip

Tube not press

tightly

Retaining collar not

pitched down

properly

1 Press the gastric

tightly

2 Pinch the

retaining collar

well


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Cathartics

Indication

Only given in the first dose of charcoal, subsequent doses should be

without catharticContraindication:

Children < 1 yrs old

Presence with diarrhea

Absent of bowel sound

Toxin expected induce diarrhea

Dosing:

70% Sorbital:

Adult: 0.5 - 1 gm/ kgChildren: 0.5 gram / kg max dose 50 gm of 35% in children > 5 yrs

Precaution:

Repeat dose will cause dramatic fluid shift - hypernatremia

WBI is much safer than cathartics

Documents

GI Decontamination Lite (Revised 15DEC09)[1]