Gastric lavage: Difference between revisions
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==Background== | ==Background== | ||
* | *Gastrointestinal decontamination technique meant to empty stomach of toxic substances<ref>https://litfl.com/gastric-lavage/</ref> | ||
*Once widely used, now rarely applied | |||
**Little evidence for efficacy | |||
**High risk of complications | |||
*Almost never used in conscious and cooperative patients | *Almost never used in conscious and cooperative patients | ||
* | **Especially lacks utility when oral [[activated charcoal]] is likely to be successful | ||
==Indications== | ==Indications== | ||
*Life-threatening poisoning (or history is not available) and unconscious presentation | *Life-threatening poisoning (or history is not available) and unconscious presentation (eg [[Colchicine]]) | ||
*Life-threatening poisoning and presentation within 1 hour | *Life-threatening poisoning and presentation within 1 hour | ||
*Life-threatening poisoning with drug with anticholinergic effects and presentation within 4 hours | *Life-threatening poisoning with drug with [[anticholinergic]] effects and presentation within 4 hours | ||
*Ingestion of sustained release preparation of significantly toxic drug | *Ingestion of sustained release preparation of significantly toxic drug | ||
*Large salicylate poisonings presenting within 12 hours | *Large [[salicylate]] poisonings presenting within 12 hours | ||
*Iron or lithium | *[[Iron toxicity|Iron]] or [[lithium toxicity]] | ||
*Paraquat ingestion (common in developing world) | |||
==Contraindications== | ==Contraindications== | ||
| Line 19: | Line 23: | ||
*A highly efficient antidote such as [[NAC]] is available | *A highly efficient antidote such as [[NAC]] is available | ||
==Technique== | ==Technique<ref>https://litfl.com/gastric-lavage/</ref>== | ||
# | #[[Intubate]] patient | ||
# | #Place patient in left lateral decubitus position with head 20 degrees downward | ||
#Externally measure length of lavage tube needed to reach stomach | |||
#Lubricate appropriately sized lavage tube and gently pass through esophagus to stomach | |||
#*Adults and adolescents: 36–40 French | #*Adults and adolescents: 36–40 French | ||
#*Children: 22–28 French | #*Children: 22–28 French | ||
# | #Confirm placement of tube | ||
#* | #*Aspiration of gastric contents | ||
#*Auscultation of air over the epigastrium | |||
# | #*XR | ||
# | #Using funnel or lavage syringe, aspirate any stomach contents | ||
# | #Gently instil 200 - 250 mL warned saline into the stomach for adults, or 10 - 15 mL/kg for children (to maximum 250 mL) | ||
# | #Allow instilled saline to flow out of tube and into bucket near bed | ||
# | #Repeat instillation and drainage until effluent is clear | ||
# | #Once effluent is clear, may instil activated charcoal if indicated | ||
==Complications== | ==Complications== | ||
| Line 38: | Line 44: | ||
*Aspiration of gastric contents (3% of patients) | *Aspiration of gastric contents (3% of patients) | ||
*[[Esophageal Rupture]] (rare) | *[[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 | *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 | **[[Atropine]] should be used to block the increased vagal tone associated with the procedure in these situations | ||
==See Also== | ==See Also== | ||
*[[Activated Charcoal]] | *[[Activated Charcoal]] | ||
*[[Whole Bowel Irrigation]] | *[[Whole Bowel Irrigation]] | ||
==External Links== | |||
===Videos=== | |||
{{#widget:YouTube|id=7VVCmCkqd9Y}} | |||
==References== | ==References== | ||
Latest revision as of 13:33, 29 June 2021
Background
- Gastrointestinal decontamination technique meant to empty stomach of toxic substances[1]
- 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
- Paraquat ingestion (common in developing world)
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[2]
- Intubate patient
- Place patient in left lateral decubitus position with head 20 degrees downward
- Externally measure length of lavage tube needed to reach stomach
- Lubricate appropriately sized lavage tube and gently pass through esophagus to stomach
- Adults and adolescents: 36–40 French
- Children: 22–28 French
- Confirm placement of tube
- Aspiration of gastric contents
- Auscultation of air over the epigastrium
- XR
- Using funnel or lavage syringe, aspirate any stomach contents
- Gently instil 200 - 250 mL warned saline into the stomach for adults, or 10 - 15 mL/kg for children (to maximum 250 mL)
- Allow instilled saline to flow out of tube and into bucket near bed
- Repeat instillation and drainage until effluent is clear
- 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
External Links
Videos
{{#widget:YouTube|id=7VVCmCkqd9Y}}
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