Gastric lavage

Background

Gastrointestinal decontamination technique meant to empty stomach of toxic substances^[1]
Once widely used, now rarely applied
- Little evidence for efficacy
- High risk of complications
Almost never used in conscious and cooperative patients
- Especially lacks utility when oral activated charcoal is likely to be successful

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 toxicity
Paraquat ingestion (common in developing world)

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

Intubate patient
Place patient in left lateral decubitus position with head 20 degrees downward
Externally measure length of lavage tube needed to reach stomach
Lubricate appropriately sized lavage tube and gently pass through esophagus to stomach
- Adults and adolescents: 36–40 French
- Children: 22–28 French
Confirm placement of tube
- Aspiration of gastric contents
- Auscultation of air over the epigastrium
- XR
Using funnel or lavage syringe, aspirate any stomach contents
Gently instil 200 - 250 mL warned saline into the stomach for adults, or 10 - 15 mL/kg for children (to maximum 250 mL)
Allow instilled saline to flow out of tube and into bucket near bed
Repeat instillation and drainage until effluent is clear
Once effluent is clear, may instil activated charcoal if indicated

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

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

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