Gastric

lavage In medicine, therapeutic irrigation or lavage ( or ) is cleaning or rinsing. Types Specific types include: * Antiseptic lavage * Bronchoalveolar lavage * Gastric lavage * Diagnostic peritoneal lavage, Peritoneal lavage * Arthroscopic lavage * Duc ...

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

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

. Since its first recorded use in 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 Poison is a chemical substance that has a detrimental effect to life. 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 figuratively, with a broa ...

or overdosed on a

drug A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via inhala ...

such as

ethanol Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...

. They may also be used before

surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

, to clear the contents of the

digestive tract The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...

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 is always an important sign. 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 abo ...

. 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 is used, as children are more at risk of developing

hyponatremia Hyponatremia or hyponatraemia is a low concentration of sodium in the 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. Symptoms can be a ...

if lavaged with water. Because of the possibility of vomiting, a suction device is always on hand in case of pulmonary aspiration 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. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blak ...

before performing lavage. The person must be put to sleep 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 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 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 reason to use a certain tre ...

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, v ...

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". Antidotes for anticoagulants are s ...

. It is also contraindicated in case of

aluminum phosphide Aluminium phosphide is a highly toxic inorganic compound with the chemical formula AlP, used as a wide band gap semiconductor and a fumigant. This colorless solid is generally sold as a grey-green-yellow powder due to the presence of impurities a ...

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 inc ...

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

laryngospasm Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds. The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration, while exhal ...

, hypoxia,

bradycardia Bradycardia (also sinus bradycardia) is a slow resting heart rate, commonly under 60 beats per minute (BPM) as determined by an electrocardiogram. It is considered to be a normal heart rate during sleep, in young and healthy or elderly adults, ...

epistaxis A nosebleed, also known as epistaxis, is 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 significant that low bl ...

hypochloremia Hypochloremia (or Hypochloraemia) is an electrolyte disturbance in which there is an abnormally low level of the chloride ion in the blood. The normal serum range for chloride is 97 to 107 mEq/L. It rarely occurs in the absence of other abno ...

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

, or mechanical injury to the stomach.

References

External links

NIH/Medline
{{Digestive system procedures Toxicology treatments