Gastric lavage

Background

• Gastrointestinal decontamination technique meant to empty stomach of toxic substances
• Once widely used, now rarely applied
  • Little evidence for efficacy
  • High risk of complications
• Almost never used in conscious and cooperative patients
  • Especially lacks utility when oral activated charcoal is likely to be successful

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 toxicity

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

1. Intubate patient
2. Place patient in left lateral decubitus position with head 20 degrees downward
3. Externally measure length of lavage tube needed to reach stomach
4. Lubricate appropriately sized lavage tube and gently pass through esophagus to stomach
   • Adults and adolescents: 36–40 French
   • Children: 22–28 French
5. Confirm placement of tube
   • Aspiration of gastric contents
   • Auscultation of air over the epigastrium
   • XR
6. Using funnel or lavage syringe, aspirate any stomach contents
7. Gently instil 200 - 250 mL warned saline into the stomach for adults, or 10 - 15 mL/kg for children (to maximum 250 mL)
8. Allow instilled saline to flow out of tube and into bucket near bed
9. Repeat instillation and drainage until effluent is clear
10. Once effluent is clear, may instil 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

• Activated Charcoal
• Whole Bowel Irrigation

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