Gastric Lavage

Gastric Lavage: Stomach Cleaning Process

Gastric lavage is a method to cleanse the stomach contents.

Definition:

Gastric lavage is a gastrointestinal decontamination technique. It involves repeatedly introducing and removing small amounts of fluid into the stomach via a tube inserted through the nose or mouth (nasogastric or orogastric tube). This procedure aims to eliminate toxic substances from the stomach. Essentially, it’s a stomach washout using a tube.

Purpose of Lavage:

Lavage is performed to:

• Cleanse the stomach: For instance, after ingesting poison or overdosing on medication.

• Manage GI bleeding: To help control gastrointestinal hemorrhage.

If a patient doesn’t already have a nasogastric tube, a doctor will order the insertion of a suitable tube before lavage.

Indications for Gastric Lavage:

1. Toxic Substance Ingestion: To remove harmful or poisonous substances from the stomach before they are absorbed into the body.

2. Pre-Endoscopy Preparation: To clear stomach contents before upper endoscopy, improving visualization during the procedure.

3. Stomach Acid Collection: To obtain stomach acid samples for diagnostic tests.

4. Gastric Pressure Relief: To reduce pressure in the stomach caused by blockages in the stomach or nearby digestive tract, alleviating discomfort and preventing complications.

5. Sputum Collection in Children: To collect sputum samples from children unable to cough it up, particularly for suspected pulmonary tuberculosis.

6. Cooling in Hyperthermia: As a cooling method for patients with high body temperature, using cool fluid irrigation to lower body temperature.

7. Gastric Hemorrhage Diagnosis: As a diagnostic tool for inflammatory conditions like gastric bleeding, by examining lavage fluid for signs and severity of hemorrhage.

8. Poisoning Cases: Frequently used in poisoning situations, especially when severe or patient history is unknown, to eliminate toxins and decrease poison absorption.

9. Specific Ingested Substances: Including:

   • Life-threatening substances: e.g., chloroquine, tricyclic antidepressants like amitriptyline or imipramine.

   • Non-absorbable substances in large quantities: e.g., iron, lithium.

   • Bezoar-forming substances: e.g., iron salicylates such as aspirin (acetylsalicylic acid). Bezoars are masses trapped in the digestive system.

Contraindications of Gastric Lavage:

• Unconscious or Seizing Patients: Not suitable for comatose or convulsing patients.

• Corrosive Substance Ingestion: Avoid if strong acids or alkalis were ingested, as it can worsen damage to the esophagus and stomach.

• Large Pills: If ingested pills are too large to pass through the lavage tube.

• Risk of Hemorrhage or Perforation: Not for patients with conditions predisposing them to bleeding or gastrointestinal rupture.

• Hydrocarbon and Detergent Ingestion: Contraindicated for substances like ethanol (a hydrocarbon) and detergents.

• Non-Toxic Poison: If the ingested poison is not harmful even at any dose.

• Charcoal Adsorption Effective: If activated charcoal can effectively absorb the poison and the ingested amount is within charcoal’s capacity.

• Late Presentation Post-Poisoning: May not be helpful if performed many hours after poisoning.

• Effective Antidote Available: May be unnecessary if a highly effective antidote for the poison exists.

Complications of Gastric Lavage:

• Increased Small Bowel Tablet Delivery: May push pills further into the small intestine, potentially increasing absorption.

• Aspiration of Gastric Contents: Risk of stomach contents entering the lungs, leading to respiratory issues (occurs in roughly 3% of cases).

• Esophageal Rupture: Rare, but a possible risk during the procedure.

• Cardiac Issues: In certain poisonings (e.g., propranolol, calcium channel blockers), it can cause severe bradycardia, cardiac arrest, or asystole due to effects on heart function.

• Nasal Trauma: Tube insertion can cause injury to the nasal passages.

• Tracheal Intubation Need: May require intubation to protect the airway before lavage, especially if airway protection is compromised.

• Electrolyte Imbalance and Hypothermia: Large fluid volumes can lead to electrolyte disturbances and decreased body temperature.