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Gastric lavage
From WikEM
Contents
Background
- Of limited/infrequent utility
- Almost never used in conscious and cooperative patients
- Restricted to poisonings where benefits over oral Activated Charcoal are likely
Indications
- Life-threatening poisoning (or history is not available) and unconscious presentation (eg Colchicine)
- Life-threatening poisoning and presentation within 1 hour
- Life-threatening poisoning with drug with anticholinergic effects and presentation within 4 hours
- Ingestion of sustained release preparation of significantly toxic drug
- Large salicylate poisonings presenting within 12 hours
- Iron or lithium poisoning
Contraindications
- Corrosive ingestions or esophageal disease
- The poison ingestion is not toxic at any dose
- The poison ingestion is adsorbed by charcoal and adsorption is not exceed by quantity ingestion
- Presentation many hours after poisoning
- A highly efficient antidote such as NAC is available
Technique
- Protect airway (endotracheal intubation) if patient is stuporous or comatose
- Select the correct tube size
- Adults and adolescents: 36–40 French
- Children: 22–28 French
- Lie patient in the left lateral decubitus position.
- The pylorus points upward in this orientation and it helps prevent the poison from passing through the pylorus during the procedure.
- Measure the length of the tubing. The length should allow the most proximal tube opening to be passed beyond the lower esophageal sphincter.
- Insert the tubing and confirm that the distal end of the tube is in the stomach.
- Withdrawal any material present in the stomach and immediately install activated charcoal if the poison is possibly adsorbed by charcoal.
- In adults, 250mL of a room temperature saline lavage solution is instilled via a funnel or lavage syringe.
- In children, 10 to 15 mL/kg is instilled to a maximum of 250 mL.
- Orogastric lavage should continue for at least several liters in an adult and for at least 0.5 to 1.0 L in a child or until no particulate matter returns and the effluent lavage solution is clear.
- After orogastric lavage, the same tube can instill another dose of activated charcoal if indicated
Complications
- Increase gastric delivery of tablets into the small bowel
- Aspiration of gastric contents (3% of patients)
- Esophageal Rupture (rare)
- Profound bradycardia, cardiac arrest, and asystole may be precipitated by lavage in poisonings with propranolol, calcium channel blockers and other drugs affecting cardiac conduction
- Atropine should be used to block the increased vagal tone associated with the procedure in these situations
See Also
References
- Benson BE et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clinical Toxicology 2013;51:140-146.
- Vale JA. Position statement: gastric lavage. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1997;35(7):711-9
