Gastric lavage: Difference between revisions
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==Contraindications== | ==Contraindications== | ||
*Corrosive ingestions or esophageal disease | *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== | ==Technique== | ||
Revision as of 13:55, 27 December 2015
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
- 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
- Lie patient on their left side
- Insert a large bore double lumen orogastric tube
- Aspirate stomach contents
- Use a small cycle lavage of 50-100 mL (and then aspirate)
- Lavage is rarely indicated beyond 5min, unless tablets are still actively being returned
- It is no longer recommended to have a completely clear return before ceasing lavage
Complications
- Increase gastric delivery of tablets into the small bowel
- Aspiration of gastric contents (3% of pts)
- 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
- 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