College of Veterinary Medicine

Small Animal DX & Therapeutic Techniques

Gastric Intubation


 
The indications for gastric intubation include:
  • emptying and gavage of the stomach in cases of suspected or known poisoning
  • relief of gaseous distension in animals with gastric dilatation volvulus
  • short-term administration of nutrients
  • administration of diagnostic solutions such as barium

General gastric intubation is performed using a large bore gastric tube. The diameter of the tube should be approximately the same size as an endotracheal tube that would be used in the same animal.

The length of the tube should be measured from the tip of the nose to approximately the 9th intercostal space in order to assure that the tip of the gastric tube is within the lumen of the stomach.  Place a tape marker (orange tape pointed to by blue arrow) to mark the proper distance.
Over-insertion can result in the tube hitting the gastric wall, flipping 180 degrees, and exiting back into the esophagus. Large diameter tubes are by nature very stiff. Care should be used in their placement, as gastric perforation can occur. The tube should be well lubricated.  Notice that the tube pictured has an end hole as well as side holes (indicated by blue arrow).

Orogastric intubation is usually performed in the awake animal with physical restraint when the purpose is to relieve gas distention or administer barium. If the purpose is to gavage to remove toxic contents, heavy sedation or anesthesia is needed.

If awake, the animal is restrained in sternal recumbency with the head in a neutral position.

A speculum is placed to prevent the animal from chewing the gastric tube. Commercial speculums are available. A 1 inch roll of tape makes an excellent speculum and is minimally traumatic. 

A large bore (12 ml) syringe casing cut off at the end can also be used as a speculum, but the rough plastic is more traumatic to the oral mucosa. The plastic speculum can be wrapped with adhesive tape to reduce trauma to the oral membranes. The speculum is placed between the dental arcades and the muzzle is held to prevent the animal from spitting out the speculum.

The tube is introduced into the oral cavity with the head in a normal position, not extended, not flexed.

 

You may be able to observe the tube passing on the left side of the animal’s cervical region as it passes through the cervical esophagus or you may palpate the gastric tube in the cervical region, dorsal to the trachea.
When the tube meets the cardia of the stomach there may be some degree of resistance. This is especially true if the stomach is distended with solid matter or air. A gentle rotation of the gastric tube may be necessary to pass through the lower esophageal sphincter into the stomach.

Depending upon the gastric contents, when the tube enters the gastric lumen, air may rush out, fluid may rush out, or you may have no identifiable sensation that the tube is in the gastric lumen. The tube should be inserted to the previously measured length (orange tape).

Effective gastric lavage generally requires the animal be sedated or anesthetized. The animal should have a cuffed endotracheal tube in place, and the insufflation of the cuff should be checked immediately before passing the gastric tube. 

 

The animal’s head should be lowered. 

Water, saline or a fluid solution containing activated charcoal should be instilled in volumes of 5-10 ml/kg. After each fluid installation, the fluid should either be drained out by gravity, or aspirated out by using a syringe or suction pump. The gavage should be repeated 8-10 times.

 

The animal needs to be carefully monitored when recovering from the anesthesia so that it does not vomit and aspirate residual gavage solution.

 
Last Edited: Feb 02, 2009 1:40 PM   

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