Gastric lavage, also commonly calledstomach pumping orgastric washing orgastric suction, is the process of cleaning out the contents of thestomach using a tube. Since its first recorded use in the early 19th century, it has become one of the most routine means of eliminating poisons from the stomach.[1] Such devices are normally used on a person who has ingested apoison oroverdosed on adrug such asethanol. They may also be used beforesurgery, to clear the contents of thedigestive tract before it is opened.
Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract.[2] It may play a role in the evaluation ofhematemesis. It can also be used as a cooling technique forhyperthermic patients.[3]
Gastric lavage involves the passage of a tube (such as anEwald tube)via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid. The placement of the tube in the stomach must be confirmed by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs.
In adults, small amounts of warm water or saline are administered and, via a siphoning action, removed again. In children,normal saline is used, as children are more at risk of developinghyponatremia if lavaged with water. Because of the possibility of vomiting, a suction device is always on hand in case ofpulmonary aspiration of stomach contents. Lavage is repeated until the returning fluid shows no further gastric contents.
If the patient is unconscious or cannot protect their airway then the patient should beintubated before performing lavage.[according to whom?] The person must be anaesthetised for a period of time during the operation due to its high risk of shock andhyponatremia.[citation needed]
Gastric lavage is used infrequently in modern poisoning treatment. Some authorities have actually suggested that it not be used routinely, if ever, in poisoning situations.[4] Lavage should only be considered if the amount of poison ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion.[5] Lavage is also the initial treatment forduodenal atresia in newborns, a condition where the small intestine is closed distal to the stomach, causing food and fluid to accumulate in the stomach. When the body temperaturerises above 40 °C, gastric lavage with iced saline also can be an aggressive cooling measure in amedical emergency.
Lavage iscontraindicated when patients have a compromised, unprotected airway and in patients at risk of gastrointestinalhemorrhage or perforation. Relative contraindications include when the poisoning is due to a corrosive substance (strong acids or strong bases) (T54), hydrocarbons (T53), or for poisons that have an effectiveantidote.
Many complications have been reported, although it appears serious complications are uncommon. The most dangerous risk isaspiration pneumonia, which is more likely to occur if hydrocarbons are ingested in patients without a protected airway. Other complications includelaryngospasm,hypoxia,bradycardia,epistaxis,hyponatremia,hypochloremia,water intoxication, or mechanical injury to the stomach.[citation needed]
| Fields | |
|---|---|
| Concepts | |
| Treatments | |
| Incidents | |
| Related topics | |
