Gastric lavage: Difference between revisions
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==Background== | ==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== | ==Indications== | ||
# Life-threatening poisoning (or history is not available) and unconscious presentation | #Life-threatening poisoning (or history is not available) and unconscious presentation | ||
# 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 | ||
# Large salicylate poisonings presenting within 12 hours | #Large salicylate poisonings presenting within 12 hours | ||
# Iron or lithium poisoning | #Iron or lithium poisoning | ||
==Contraindications== | ==Contraindications== | ||
===Absolute=== | ===Absolute=== | ||
# Corrosive ingestions or | #Corrosive ingestions or esophageal disease | ||
==Technique== | ==Technique== | ||
# Protect airway (endotracheal intubation) if patient is stuporous or comatose | #Protect airway (endotracheal intubation) if patient is stuporous or comatose | ||
# Lie patient on their left side | #Lie patient on their left side | ||
# Insert a large bore double lumen orogastric tube | #Insert a large bore double lumen orogastric tube | ||
# Aspirate stomach contents | #Aspirate stomach contents | ||
# Use a small cycle lavage of 50-100 mL (and then aspirate) | #Use a small cycle lavage of 50-100 mL (and then aspirate) | ||
# Lavage is rarely indicated beyond | #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 | |||
It is no longer recommended to have a completely clear return before ceasing | |||
==Complications== | ==Complications== | ||
# Increase gastric delivery of tablets into the small bowel | #Increase gastric delivery of tablets into the small bowel | ||
# Aspiration of gastric contents (3% of | #Aspiration of gastric contents (3% of pts) | ||
# [[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]] | ||
==Source== | ==Source== | ||
Revision as of 07:43, 20 December 2011
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
Absolute
- Corrosive ingestions or esophageal disease
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
Source
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