Page 102 - JSOM Spring 2018

NOTE: If you are not trained to perform gastric decompres- not available, clean the area with 70% isopropyl alcohol
sion, then transport immediately to the nearest veterinary or other medical-grade skin antiseptic agent, if available.
clinic. 3. Insert a large bore (e.g.,10–16 gauge × 3.25 inches) over-the-
needle catheter at the location chosen. Insert the catheter at
Gastric Decompression a 90° angle (perpendicular) to the body wall. Alternatively,
Of importance, gastric decompression is a technique to tran- since the stomach naturally resides in the cranial abdomen
siently treat GDV; it does not cure or definitively fix the patho- under the last three ribs, consider inserting the catheter at
logic condition. Definitive care involves surgical intervention a slight angle (e.g., 50°–60°) cranial (i.e., toward the head);
to reposition (derotate) the stomach, followed by affixing the this allows the catheter to trace the pathway of the stomach
stomach to the internal abdominal wall (gastropexy). Gas- as it deflates.
tric decompression allows restoration of venous return to the 4. Confirm successful gastric trocarization via the sound of
heart, increased cardiac output, and return of effective ventila- hissing and presence of foul-smelling gas; additionally, fluid
tion. Ideally, gastric decompression is performed after cardio- may begin to flow (or spurt) out of the needle.
vascular resuscitation with IV/IO fluid therapy. Restoration of 5. Seat the catheter fully into the gastric lumen by sliding
circulation after gastric decompression may result in reperfu- (feeding) the catheter off the stylet into the stomach until
sion injury that may initially lead to further cardiovascular the catheter hub is flush with the body wall. If possible,
compromise. The ability to initiate fluid resuscitation is not secure the stylet in a sterile and safe location in case it is
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always available in the field. However, it is the author’s opin- needed for subsequent GNDC.
ion and recommendation, based on clinical experience, that 6. While maintaining positive control of the catheter hub
gastric decompression is still warranted in this situation. against the body wall, compress both sides of the abdomen
together (i.e., like an accordion); this facilitates keeping the
Methods for gastric decompression include orogastric (OG) catheter inside the gastric lumen as the stomach deflates,
intubation (a.k.a., stomach tube) and GNDC. OG intubation and it forces gas to escape.
is not recommendedfor field or prehospital use for the follow- 7. Remove the catheter at the same angle it was inserted once

ing reasons : (1) it is a painful procedure requiring appropriate no further gas is heard escaping from the catheter and the
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and effective sedation and analgesia; (2) it is a technical and abdomen appears significantly less distended.
perishable skill for those not familiar with or who do not rou- 8. Repeat GNDC if clinical signs return. Inform the receiving
tinely perform OG intubations in canines; (3) it carries a risk facility of the number of attempts (successful or not) and
for aspiration pneumonitis/pneumonia; and (4) it comes with location of GNDC.
the added risk of causing esophageal and/or gastric perfora-
tion. In addition, inability to pass an OG tube is reported to NOTE: Do not leave the catheter in place in hope of pro-
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occur in approximately 25% of cases. 8 viding a continual pathway for gas to escape. Doing so
provides a false sense of assurance that gas is not accumu-
GNDC (a.k.a., gastric trocarization) is considered a reason- lating in the stomach. Due to its short length, the catheter

able technique for field and prehospital gastric decompression. very quickly slides out of the deflated stomach; the tip sits
As compared with OG intubation, GNDC is quicker to per- only within the abdominal cavity. Additionally, due to elas-
form, less painful, and does not require sedation or analgesia. tic motion of the canine skin, the catheter easily becomes
The latter advantage makes GNDC a better option for a he- kinked and occluded at the insertion site into the body wall.
modynamically unstable patient. In a veterinary hospital set- Some choose to leave the catheter in place, however, solely
ting, GNDC demonstrated a higher success rate for achieving for the purpose of marking the number and location of per-
gastric decompression than OG intubation. The disadvantage formed GNDCs.
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of GNDC is the small bore size of the catheter, which may pre-
clude rapid or complete evacuation of gas. As compared with Risks associated with GNDC are minimal. If GNDC is per-
OG intubation, GNDC does not afford the ability to perform formed in the absence of a GDV (e.g., due to an inaccurate field
gastric lavage and completely evacuate all stomach contents. diagnosis), the likelihood of causing any significant damage to
However, gastric lavage is not a recommended field procedure, other internal organs or structures is low. Inadvertent splenic
because of its inherent risks (e.g., aspiration) and need for gen- puncture may cause intraabdominal hemorrhage, whereas
eral anesthesia and endotracheal intubation. Overall, GNDC gastrointestinal puncture may cause leakage of contents into
remains the recommended technique for prehospital gastric the abdomen. In the author’s experience and as reported in the
decompression. GNDC is a rather simple procedure easily literature, however, these events typically do not present any
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learned by anyone. Despite its simplicity, GNDC does carry major complications or warrant any specific treatment. Even
some inherent risks; therefore, only those properly trained in if major complications develop, the OpK9 is undergoing an
the procedure should perform it. The following is a recom- open exploratory laparotomy to correct the GDV, at which
mended protocol GNDC : time, any complication may be dealt with appropriately. In
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light of any potential complications that may develop from
1. Locate area to perform GNDC: Identify the most distended GNDC, always inform the receiving facility of any attempts to
portion within the right or left abdominal flank region (i.e., perform a GNDC, successful or not.
area immediately caudal to the last rib). If no area appears
grossly distended, or both sides appear equally distended, Continuous Percutaneous Decompressive Gastrostomy
then percuss each side to identify the area that has the great- Catheter for Prolonged Field Care
est tympany (loudest hyperresonant “ping”). This identifies Percutaneous placement of a 5F locking pigtail catheter into
where the gas-filled stomach is closest to the body wall. the stomach for use as a gastrotomy catheter (G-catheter)
2. Clip a 1- to 2-inch square area of hair and clean the overly- was reported as a safe, minimally invasive, well-tolerated,
ing skin of the location identified in step 1. If clippers are and effective method for sustained gastric decompression in

96 | JSOM Volume 18, Edition 1/Spring 2018