Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, September 5, 2013

Decompression of the massively distended GDV stomach: Needle or stomach tube?

The dog presents in distress, pale mucous membranes, shock, and a has huge gas distended stomach. The owner says he has been trying to vomit for several hours but has only brought up some foamy fluid. Radiographs reveal a very large stomach filled with air and a Smurf hat appearance on the lateral view (see previous blog on diagnosis). The distended stomach is compressing the vena cava causing hypovolemia and inhibition of normal respiration by putting pressure on the diaphragm.

First step?

The two most importance initial actions in GDV are to begin intravenous fluid therapy at shock doses (90ml/kg/hr), and to decompress the stomach. Decompression can be via gastrocentesis with a needle or over-the-needle catheter or with a stomach tube. I have used both, but in a severely affected dog my first step would be to do a quick clip and prep of the lateral abdomen over the area of greatest distention and insert a large bore over the needle catheter percutaneously into the stomach to evacuate the air. In a large dog a 14 gauge, 6 inch catheter (horse jugular vein catheter) works very well.

Large bore over the needle catheter is being placed into the stomach percutaneously
Massage the abdomen to allow additional air to escape. This is a quick and effective way to initially empty the stomach and allow improvement of venous return and cardiac output.

I would then attempt to pass a stomach tube. It is not necessary to use a large stomach tube; a medium or even smaller sized tube is all that is necessary. Measure the tube from the tip of the nose to the 13th rib and place a piece of tape in that spot to serve as orientation and let you know when you are at the cardia of the stomach. Lubricate the end of the tube with KY jelly and gently pass it into the stomach. Do not try to force the tube into the stomach if you feel resistance. The gastric fundus and cardia may be compromised so gently pushing the tube in this area is important. Sometimes a slight twisting motion will help get the tube past the cardia. Try putting the dog in different positions if the tube will not pass initially. A stomach tube is more likely to remove fluid and solid debris from the stomach than gastrocentesis.

If there is an anticipated delay between initial treatment and the surgery to correct the GDV, an option to maintain decompression is to pass a nasogastric tube. Although this will be a small bore tube (a 14 Fr size tube would be ideal) it can be used to remove excessive gas from the stomach and keep the animal stable during the interim period between emergency treatment and surgery.
From: Crisp MS. Critical care techniques in Saunders Manual of Small Animal Practice.  1st edition,  Birchard and Sherding, editors, W.B. Saunders, 1994, pg 22.

Acknowledgement: Thank you to my wife Dr. Becky Ball for her help with this blog.

Next blog: Incisional gastropexy to prevent recurrence of GDV.

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