Claire Roberts rvn dipavn(Surg) vncertecc aetiology and Patient Presentation of the gdv patient

Initial Treatment Considerations

Treatment initially consists of rapid decompression of the stomach with a stomach tube. If this is unsuccessful, then trocarisation of the stomach may be necessary.

Stomach tubing is carried out in order to decompress the stomach. With this technique a wide bore stomach tube is measured from the patient’s nose to its 11th rib and marked. The tube should not be placed any further than this length to prevent accidental rupture of the gastric wall.

The initial placement of the tube can be made with the patient in a sitting position. A temporary and effective ‘gag’ can be made by placing a cohesive bandage end on between the patient’s teeth, and mouth should then be held or taped shut over this gag and the stomach tube can then be passed down the inner core of the roll. If it is not possible to access the stomach with the patient in this position then the same technique should be attempted with the patient in right lateral recumbency.

Care must be taken when passing the stomach tube as over-vigorous placement may lead to accidental rupture of the gastric wall. Once the stomach tube has been passed, gastric lavage should be carried out using copious volumes of warmed normal saline or lactated Ringer’s solution.

If stomach tubing is unsuccessful trocarisation should be performed. Trocarisation is usually performed by clipping an area over the right flank where the stomach is most distended and quickly prepping the areas as for aseptic surgery. A large bore (>16 gauge) long intravenous catheter should be placed through the skin and into the distended stomach. Correct placement of the catheter will often be confirmed by the hissing sound as the gas escapes from the stomach. This technique will cause temporary and minimal decompression of the stomach whilst further preparations can be made for continued treatment. Once the pressure in the stomach has been reduced, stomach tubing may be reattempted at this point.