Gastric lavage, also commonly called stomach pumping or gastric irrigation or gastric suction, is the process of cleaning out the contents of the

stomach The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...

using a tube. Since its first recorded use in the early 19th century, it has become one of the most routine means of eliminating poisons from the stomach. Such devices are normally used on a person who has ingested a

poison A poison is any chemical substance that is harmful or lethal to living organisms. The term is used in a wide range of scientific fields and industries, where it is often specifically defined. It may also be applied colloquially or figurati ...

or overdosed on a

drug A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...

such as

ethanol Ethanol (also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound with the chemical formula . It is an Alcohol (chemistry), alcohol, with its formula also written as , or EtOH, where Et is the ps ...

. They may also be used before

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

, to clear the contents of the

digestive tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...

before it is opened. Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract. It may play a role in the evaluation of

hematemesis Hematemesis is the vomiting of blood. It can be confused with hemoptysis (coughing up blood) or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically above the suspensory muscle of du ...

. It can also be used as a cooling technique for hyperthermic patients.

Technique

Gastric lavage involves the passage of a tube (such as an ''Ewald tube'') via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid. The placement of the tube in the stomach must be confirmed by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs. In adults, small amounts of warm water or saline are administered and, via a siphoning action, removed again. In children,

normal saline Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By intravenous therapy, inje ...

is used, as children are more at risk of developing

hyponatremia Hyponatremia or hyponatraemia is a low concentration of sodium in the Serum (blood), blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symp ...

if lavaged with water. Because of the possibility of vomiting, a suction device is always on hand in case of

pulmonary aspiration Pulmonary aspiration is the entry of solid or liquid material such as pharyngeal secretions, food, drink, or stomach contents from the oropharynx or gastrointestinal tract, into the trachea and lungs. When pulmonary aspiration occurs during ea ...

of stomach contents. Lavage is repeated until the returning fluid shows no further gastric contents. If the patient is unconscious or cannot protect their airway then the patient should be

intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to supp ...

before performing lavage. The person must be anaesthetised for a period of time during the operation due to its high risk of shock and

Indications

Gastric lavage is used infrequently in modern poisoning treatment. Some authorities have actually suggested that it not be used routinely, if ever, in poisoning situations. Lavage should only be considered if the amount of poison ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion. Lavage is also the initial treatment for

duodenal atresia Duodenal atresia is the congenital absence or complete closure of a portion of the lumen (anatomy), lumen of the duodenum. It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies. ...

in newborns, a condition where the small intestine is closed distal to the stomach, causing food and fluid to accumulate in the stomach. When the body temperature rises above 40 °C, gastric lavage with iced saline also can be an aggressive cooling measure in a

medical emergency A medical emergency is an acute injury or illness that poses an immediate risk to a person's life or long-term health, sometimes referred to as a situation risking "life or limb". These emergencies may require assistance from another, qualified ...

Contraindications

Lavage is

contraindicated In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient. Contraindication is the opposite of indication, which is a rea ...

when patients have a compromised, unprotected airway and in patients at risk of gastrointestinal

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, ...

or perforation. Relative contraindications include when the poisoning is due to a corrosive substance (strong acids or strong bases) (), hydrocarbons (), or for poisons that have an effective

antidote An antidote is a substance that can counteract a form of poisoning. The term ultimately derives from the Greek term φάρμακον ἀντίδοτον ''(pharmakon antidoton)'', "(medicine) given as a remedy". An older term in English which is ...

. It is also contraindicated in case of aluminum phosphide poisoning.Principle of FMT-Rajesh Bardale

Complications

Many complications have been reported, although it appears serious complications are uncommon. The most dangerous risk is

aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may incl ...

, which is more likely to occur if hydrocarbons are ingested in patients without a protected airway. Other complications include laryngospasm, hypoxia,

bradycardia Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due ...

epistaxis A nosebleed, also known as epistaxis, is an instance of bleeding from the nose. Blood can flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significan ...

, hypochloremia,

water intoxication Water intoxication, also known as water poisoning, hyperhydration, overhydration, or water toxemia, is a potentially fatal disturbance in brain functions that can result when the normal balance of electrolytes in the body is pushed outside safe ...

, or mechanical injury to the stomach.

References

External links

NIH/Medline
{{Digestive system procedures Toxicology treatments