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Risk Management Pitfalls For Gastrointestinal Decontamination
1. “I wanted to do SOMETHING for this child. His parents brought him all the way here and were very worried.”
2. “He was too sleepy to drink the activated charcoal, so we gave it via NG tube.”
3. “If a patient presents with an overdose, I pump the stomach! Isn’t that standard of care?”
4. “Why did I need to listen to bowel sounds before starting whole bowel irrigation?”
5. “But the preprinted discharge instructions said to keep a bottle of ipecac at home, so I prescribed it.”
Perhaps the hardest thing to do for children who present after an ingestion is nothing. When a child presents more than 1 hour after ingestion, there is no conclusive evidence for decontamination of any method.
2. “He was too sleepy to drink the activated charcoal, so we gave it via NG tube.”
Children with depressed mental status are at high risk of aspiration and should have an airway secured prior to any method of decontamination. It is essential to thoroughly assess the patient’s mental status, including his or her ability to protect the airway, before treatment.
3. “If a patient presents with an overdose, I pump the stomach! Isn’t that standard of care?”
Gastric lavage, or ‘pumping the stomach,’ is not standard of care for adults or children who have ingested a toxin. The available evidence shows that it adds no benefit to SDAC in poisoned patients. In addition, it carries a significant risk of aspiration.
4. “Why did I need to listen to bowel sounds before starting whole bowel irrigation?”
Whole bowel irrigation is contraindicated in patients with ileus or bowel obstruction. Therefore, the presence of bowel sounds should be confirmed prior to starting treatment.
5. “But the preprinted discharge instructions said to keep a bottle of ipecac at home, so I prescribed it.”
Although syrup of ipecac was recommended by the AAP in 1983, it is no longer standard of care. The AACT and AAP policies do not support its use in the home or ED. Parents should dispose of any syrup of ipecac in the home and contact the poison control center for guidance in case of a toxic ingestion.
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