Lavage Tube Research Articles

Superior Mesenteric Artery Syndrome Leading to Acute Gastric Dilatation in a Woman with Bulimia

Superior mesenteric artery (SMA) syndrome is a rare clinical disease defined as compression of the third part of the duodenum between the aorta and the SMA. Severe complications of SMA syndrome include acute gastric dilatation which is uncommon but potentially fatal and requires immediate intervention. This report describes a 29‐year‐old woman with SMA syndrome complicated by acute gastric dilatation. It was diagnosed by computerized tomography. The patient had a history of treatment of bulimia nervosa but defaulted 3 months ago. She presented with severe abdominal distension and extreme abdominal pain due to massive gastric dilatation after an eating binge. Gastric decompression was successful with a modified gastric lavage tube with additional large holes at the tip.

Abdominal compartment syndrome caused by a bulimic attack in a bulimia nervosa patient

We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.

Clearance of focal lesion plus irrigation with two connecting lavage tubes for postoperative femoral in fection in 76 patients

Objective To explore a more effective way of lavage so as to improve the curative effect of management for postoperative femoral infection.Methods A retrospective analysis was performed in 76 patients who received lavage therapy by using two connecting lavage tubes admitted into Department of Orthopedics,Second Hospital of Tangshan from March 2001 to May 2008.The advantages and disadvantages of this lavage method were discussed.Results All the wounds in 76 patients were healed at one stage.There was no recurrence after more than six months of follow-up.Conclusion Lavage using two connecting lavage tubes is an modification to conventional lavage,for it can reduce loss rate and blocking rate of the irrigation tube. Key words: Irrigation; Femur; Surgical wound infection

The curative affect of inserting gastric lavage tube through the mouth in the unconscious and poisoning patients

Objective To explore the method of inserting gastric lavage tube through the mouth in the unconseious and poisoning patients.Methods There are 40 cases which are poisoning unconscious patients related with oral.Divided them into 2 groups by the order.The experimental group is lavaged by putting lavage tube from mouth.The control group is lavaged by putting lavage tube from nose.Then write down the time for putting the lavage tube from mouth and nose separately.Results The average catheter time for insertion of the experimental group has reduced.And the achievement ratio of intubation has increased.Comparing patients' blood pressure,heart rate and peripheral oxygen saturation per minute in these two groups after the insertion of tube.There are significant difference.Pvalue＜0.01 the differences have statistical signifieanee.Conclusions Oral intubation with a gastric tube could not only cure the uneonscioas and poisoning patients timely but also reduce the danger of intubation injury and ensure the safety of emergency nursing care skill. Key words: Intubation; Gastric tube; Unconscious; Effect

Gastric Lavages Versus Intravenous Erythromycin Prior to Urgent Endoscopy for Acute Upper Gastrointestinal Bleeding: A Randomized Trial-Preliminary Results

Introduction: The diagnostic and therapeutic capacity of the endoscopy in patients with acute upper gastrointestinal bleeding (UGB) is limited by the presence of clots. Different suggesting studies have published that the previous administration of a bolus of intravenous erythromycin improves stomach cleansing before endoscopy. There is not any work that compares the nasogastric tube lavages with the infusion of erythromycin prior to the endoscopy. Aim: determining if the quality of vision of the urgent endoscopy in patients with UGB after administering intravenous erythromycin is comparable to the one obtained with gastric lavages by nasogastric tube.

Technical note: Bacterial diversity and fermentation end products in rumen fluid samples collected via oral lavage or rumen cannula

A study was conducted to determine if sampling rumen contents via a ruminal cannula or oral lavage tube would yield similar denaturing gradient gel electrophoresis profiles of the bacterial community. Two species of ruminally cannulated animals were used for this study (cattle, n = 2; sheep, n = 3). All animals were allowed ad libitum access to feed. Cattle were fed baled unprocessed sorghum-sudan hay (12% CP, 68% NDF; DM basis), whereas sheep were maintained on chopped alfalfa (18% CP, 40% NDF; DM basis). Ruminal fluid was collected (approximately 20 mL) once per week for 3 wk from each animal using a poly tube equipped with a suction strainer with a hand-held suction pump through the rumen cannula or oral cavity. The denaturing gradient gel electrophoresis analysis demonstrates that yield of bacterial diversity was not different between the 2 sampling methods (P = 0.73). When samples were grouped according to band pattern similarity, groups were most stable according to individual animal and species rather than sampling method. Total VFA and molar proportions of individual VFA did not differ by sampling method (P > 0.40). Additionally, rumen ammonia concentrations were similar for both sampling methods (19.3 vs. 19.1 mM +/- 8.0 for cannula vs. lavage, respectively; P = 0.98). These data indicate that rumen samples collected via oral lavage or rumen cannula yield similar results. This knowledge will allow sample collection from a greater population of animals and an ability to maintain the value of research livestock that can be lost due to the surgical implantation of a ruminal cannula.

Indicadores de calidad para la asistencia urgente de pacientes con intoxicaciones agudas (Calitox-2006)

We present a map of 24 indicators to measure the quality of care given to patients with acute poisoning attended in the emergency department. These include structural indicators (availability of protocols, stocks of antidotes, analytical tests, gastric lavage tubes), process indicators (correct indication of gut decontamination techniques, indications for renal and extra-renal purification, use of antidotes, indication of toxicological analyses, ECG, delays in care, psychiatric referrals, judicial notifications), indicators of results (mortality, compliance with minimum basic data set of poisonings, continuing staff education) and administrative indicators (publications).

Management of Unilateral Airway Obstruction During Nasotracheal Intubation

Nasotracheal intubation is commonly used in patients undergoing maxillofacial surgery. The tracheal tube is passed through the nasal cavity after induction of anesthesia, followed by direct laryngoscopy to insert the tube into the trachea under direct vision by using Magill forceps. Various complications resulting from nasal passage of the tube, such as epistaxis, turbinectomy or retropharyngeal dissection, have been reported. The most common complication of nasotracheal intubation is epistaxis and several recommendations have been made to reduce its incidence. In spite of efforts such as local application of vasoconstrictive drugs, thermosoftening of the tube, and use of a nasopharyngeal airway as a pathfinder, epistaxis cannot be prevented entirely. This case report describes an 18-year-old female patient with difficult nasal intubation due to narrow nasal passageway. The patient was admitted for mandible angle splitting ostectomy and angle resection for cosmetic purpose. Epistaxis had occurred due to repeated nasotracheal intubation attempts, and blood had been aspirated. After intubation, the patient was desaturated (SpO2<92%) with asymmetric inflation of the chest wall during controlled ventilation. We took frequent suction and tube lavage with saline, thereafter changed patient’s position to right lateral decubitus, and chest percussion was done with a face mask and the palm of the hand. About 20 minutes after aspiration, the SpO2 was restored to 98%, and the operation proceeded, which finished uneventfully. On the next day, the chest x-ray revealed segmental atelectatic change in the right lung field, and nasal packing was done because of recurrent epistaxis. The patient was discharged on the 4th postoperative day without complications.

Rapid, Multiwell Colorimetric Assay for Measuring Neutrophil Chemoattractant Activity in Bronchoalveolar Lavage Fluid of Horses with Recurrent Airway Obstruction

The criteria used to diagnose recurrent airway obstruction (RAO) in affected horses include demonstration of reversible lower airway obstruction and greater than 25% neutrophils in bronchoalveolar lavage fluid (BALF). Additional objective laboratory tests are needed to improve diagnostic accuracy and to monitor response to treatment. The goal of this study was to determine if neutrophil chemoattractant activity of BALF could be measured by using a previously described, rapid, multiwell colorimetric assay for chemotaxis. In this assay, neutrophils that have migrated through a membrane filter are collected into the bottom well of a disposable chemotaxis-cell migration chamber. The number of viable cells collected in the bottom well is quantified by measurement of the reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenol tetrazolium bromide (MTT), which is reduced by dehydrogenase in mitochondria of live cells. The number of migrating cells corresponds to the amount of MTT reduced, which is measured with an enzyme-linked immunosorbent assay plate reader. Fourteen adult horses were enrolled in this study, 7 of which had owner histories consistent with RAO. Each horse was sedated, a bronchoalveolar lavage tube was passed, and saline was infused and immediately aspirated. An aliquot of BALF was used for differential cell count, and BALF supernatant was harvested to assess neutrophil chemoattractant activity. Normal control horses and RAO-affected horses were distinguished according to clinical signs and percent neutrophils in BALF. Neutrophil chemoattractant activity of BALF was significantly greater in RAO-affected horses (P = 0.001) compared with control horses. This assay may be useful in future studies for monitoring response to therapy in RAOaffected horses.

Pyothorax in a cat managed by intrathoracic debridement and postoperative ventilatory support

A domestic-longhair cat presented due to lethargy, dyspnoea and hypersalivation. Radiographic examination revealed a bilateral pleural effusion, which was diagnosed as pyothorax based on cytological examination. Ultrasonographic examination revealed extensive loculations within the thoracic cavity. Exploratory sternotomy, under general anaesthesia, allowed the removal of approximately 100 ml of purulent fluid and debridement of a partially walled-off abscess and necrotic material from the pleural cavity. Postoperative positive-pressure ventilation was required due to severe respiratory depression. Intensive postoperative care, including intensive continuous monitoring, thoracostomy tube drainage and lavage of the pleural cavity and oesophagostomy tube feeding, was performed. Complete resolution of clinical signs had occurred by 15 days postoperatively. Clinical or radiographic abnormalities were not detected at a follow-up examination one year after surgery.

Eustachian tube surfactant is different from alveolar surfactant: determination of phospholipid composition of porcine eustachian tube lavage fluid

Phosphatidylcholine (PC) is the main phospholipid in lung surfactant and, more specifically, dipalmitoyl PC (PC16:0/16:0) is the major surface-active component. Several studies have tentatively shown that eustachian tube lavage fluid (ETLF) contains surface-active material. The aim of the present study was to determine, using electrospray ionization mass spectrometry, whether the phospholipid molecular species composition of ETLF is similar to that of lung surfactant. PC was the main component of both ETLF and bronchoalveolar lavage fluid (BALF). The concentration of phosphatidylethanolamine was higher and phosphatidylglycerol was undetectable in ETLF compared with BALF. The molecular species composition of PC in ETLF was notably different from that of BALF, palmitoyloleoyl PC being the major component. Importantly, given its predominance in BALF PC, the concentration of PC16:0/16:0 was low in ETLF. As expected on the basis of this molecular species composition of PC, ETLF did not generate low surface tension values under dynamic compression in a pulsating bubble surfactometer. We conclude that the surfactant in ET is different from lung surfactant, and that low surface tension is not a major determinant of ETLF function.

Esophageal laceration and charcoal mediastinum complicating gastric lavage

A 19-year-old woman underwent multiple attempts at orogastric lavage before success 5 h after ingesting approximately 24 grams of ibuprofen in a suicide attempt. Activated charcoal was administered via the lavage tube. She vomited charcoal shortly after administration and began experiencing difficulty breathing and an increase in the pitch of her voice. A chest X-ray study showed a widened mediastinum, pneumopericardium, and subcutaneous emphysema consistent with esophageal perforation that was confirmed by computed tomography scan. Surgical exploration revealed a tear in the proximal posterior esophagus with charcoal in the posterior mediastinum. She remained intubated for 7 days and was discharged 14 days after admission. This is a report of esophageal perforation with activated charcoal contamination of the mediastinum after gastric lavage. The risks and benefits of this procedure should be carefully considered in each patient prior to its use. Awake patients should be cooperative with the procedure to minimize any risk of trauma to the oropharynx or esophagus.

Pseudohemobilia: a case report

Case Presentation: Seventy eight year-old woman with hypertension, mitral valve replacement and coronary artery disease presented with melena and dizziness. She was alert, pale, had orthostatic changes in blood pressure and a positive stool hemoccult test. Orogastric tube lavage was clear. Her hematocrit dropped to 18% from her baseline of 35%. EGD revealed projectile drainage of blood from papilla of Vater along with bile. A diagnosis of hemobilia was made. Urgent celiac artery angiogram was unremarkable for a bleeding site. Hepatobiliary sonogram was normal. A duodenoscope could demonstrate bleeding close to the tip of papilla. EGD after 48 hours showed no bleeding. Colonoscopy did not demonstrate another bleeding source. She received blood transfusions and was discharged in a stable condition. Four months later she presented with melena for 1 day, with a hematocrit of 19% required blood transfusions. EGD showed no active bleeding. A duodenoscope revealed an arterio-venous malformation close to the opening of papilla of Vater.

Inferomedial placement of a single‐entry subpalpebral lavage tube for treatment of equine eye disease

AbstractThe objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31‐month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1–61 days). Seventy‐one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non‐ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.

Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease

The objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31-month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1-61 days). Seventy-one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non-ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.

Lavage Tube Sets May Separate at Joints

Lavage Tube Sets May Separate at Joints

Use of glucagon for removal of an orogastric lavage tube

This report presents the first case in which glucagon administration enabled the removal of an impacted orogastric tube in a patient with distal esophageal spasm. For patients in whom the removal of a gastric tube is impeded, we suggest initially determining tube position and checking for any knotting or kinking of the tube using fluoroscopy. Provided that the gastric tube is distal to the mid-esophagus and is not kinked or knotted, we suggest that glucagon can be used as an adjunctive modality for gastric tube removal. This care provides an additional and previously unreported use for glucagon in emergency medicine.

サーファクタント様物質と滲出性中耳炎(総説)

The cause of OME (otitis media with effusion) is not clearly known, but many studies indicate that dysfunction of the eustachian tube plays a role in its pathogenesis. The potential existence of a STLS (surface tension lowering substance) in the middle ear cavity which facilitates the opening of the eustachian tube was first postulated by Bauer in 1970.Appreciable phospholipids were shown to be present in eustachian tube lavage fluid by many investigators. The major components of pulmonary surfactant are phospholipids, especially DSPC (dipalmitoyl phosphatidylcholine). We also detected the existence of DSPC in middle ear effusions.Monoclonal antibodies against pulmonary surfactant protein were prepared by Kuroki et al. We found fine positive granules in the mucosal epithelial cells of the middle ear, while Lamellar bodies were found in the secretory cells of the middle ear by electromicroscopic examinations.Yamanaka et al reported that the positivity of SAP (surfactant apoprotein) in middle ear effusions showed a good correlation with the clinical course of OME, and the period of observation of SAP-positive cases being significantly shorter than that of SAP-negative cases.Some investigators have suggested the efficacy of treating OME with artificial pulmonary surfactant. Kobayashi et al reported that the use of artificial surfactant was effective for patients with OME.

Malposition of pediatric gastric lavage tubes demonstrated radiographically

Gastric lavage may be indicated in the initial treatment of toxic substance ingestion. We retrospectively surveyed the charts of 36 pediatric patients who underwent gastric lavage to evaluate the clinical and radiographic evidence indicating proper tube placement. Only 14 patients had a radiograph prior to lavage, and 50% of these documented malposition. The most common was excess tube insertion, stretching the stomach inferiorly towards the pelvis. The traditionally acceptable clinical test by auscultation of insufflated air was favorable in 100% of patients, thus failing to detect all of the malpositionings documented radiographically. We suggest that initial insertion of tube length be based on the patient's height or length using an adaptation of Strobel's previously published formula for esophageal pH probe placement: Tube Insertion Depth (TED), orogastric = 9.7 cm + (0.226 × length of patient in cm) and TID, nasogastric = 8 cm + (0.252 × length of patient in cm). These formulae have been displayed in graphic form for easy use. Diagnostic imaging remains the only certain means to document tube placement. Prospective studies to validate the formulae in clinical use are ongoing.

Esophageal spasm following propranolol overdose relieved by glucagon

A case of propranolol overdose complicated by esophageal spasm preventing extrication of an orogastric lavage tube and relieved by intravenous glucagon is presented. Esophageal spasm is an infrequent complication of beta-adrenergic overdose. Possible mechanisms of esophageal spasm and its relief with glucagon are discussed.