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 (TID), orogastric = 9.7 cm + (0.226 x length of patient in cm) and TID, nasogastric = 8 cm + (0.252 x 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.