Gastric lavage

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 (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 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

1. Protect airway (endotracheal intubation) if patient is stuporous or comatose
2. Select the correct tube size
   • Adults and adolescents: 36–40 French
   • Children: 22–28 French
3. Lie patient in the left lateral decubitus position.
   • The pylorus points upward in this orientation and it helps prevent the poison from passing through the pylorus during the procedure.
4. Measure the length of the tubing. The length should allow the most proximal tube opening to be passed beyond the lower esophageal sphincter.
5. Insert the tubing and confirm that the distal end of the tube is in the stomach.
6. Withdrawal any material present in the stomach and immediately install activated charcoal if the poison is possibly adsorbed by charcoal.
7. In adults, 250mL of a room temperature saline lavage solution is instilled via a funnel or lavage syringe.
8. In children, 10 to 15 mL/kg is instilled to a maximum of 250 mL.
9. Orogastric lavage should continue for at least several liters in an adult and for at least 0.5 to 1.0 L in a child or until no particulate matter returns and the effluent lavage solution is clear.
10. After orogastric lavage, the same tube can instill another dose of 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

• Activated Charcoal
• Whole Bowel Irrigation

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