gastric lavage

Indications

• poisoning (within 60-90 minutes of poison ingestion)
  • rarely removes clinically significant amount of poison
• GI bleed
  • increases likelihood of early endoscopy but not better patient outcomes

Contraindications

Caution:

• airway protection (endotracheal intubation) must preceed gastric intubation in patients
  • without gag reflex
  • with ingestion of a CNS depressant

Procedure

• nasogastric or orogastric tube is placed
  • 36-40 French (adults)
  • bite blocks are often necessary to prevent biting down on the tube
• lavage is performed in the left lateral decubitus position, head down if possible
• the stomach is irrigated with 1 liter of normal saline (or less depending upon capacity), 200-250 mL aliquots
• the fluid is then suctioned through the nasogastric tube
• the procedure is repeated until the fluid is clear or it becomes apparent that the fluid will not clear
• generally requires a minimum of 2 L (adults)
• charcoal may be administered through the gastric tube

Interpretation

• bilious fluid without blood returned from gastic lavage suggests that the gastric pylorous is open & there is no active upper GI hemorrhage proximal to the ligament of Trietz

Complications

• pulmonary aspiration
• esophageal perforation
• hypothermia
• epistaxis
• perforation of the posterior pharynx, esophagus
• installation of lavage fluid & charcoal into the lungs
• hyponatremia in small children given hypotonic lavage fluid
• gastric biopsy with the newer active pump stems

More general terms

• emergency medicine
• lavage

Additional terms

• gastrointestinal hemorrhage
• nasogastric tube (NGT) placement (gastric intubation)
• toxicity; poisoning; overdose