What is Gastric Lavage?
Gastric lavage is a medical procedure to clean contents in the stomach using water or other fluid. Lavage means washing out, and it is done when the patient has ingested poison, chemicals, drug overdose, etc.
What are its uses?
It helps in removing poisonous substances from the stomach. Toxic substances like drugs (opiates, barbiturates) and others need to be removed from the stomach before being absorbed into the body. This process clears the ingested substance by washing them out into the intestine.
Administering activated charcoal may help further limit the absorption of poison remaining in the intestine. It also helps when severe vomiting and diarrhea present along with poisoning as it will slow down the absorption of any poison remaining in the intestine.
When not to perform gastric lavage?
Lavage is contraindicated when a patient has seizures, coma, trauma, or profuse bleeding present. Lavage tube may cause injury if it passes into the head or neck region instead of the stomach. Aspiration pneumonia can also occur if stomach contents are aspirated through a lavage tube.
Lavage is avoided in patients with obstructive airway disorders due to the risk of aspiration pneumonia. It should be used with caution when there are high irritant poisons present because they can damage the mucus membrane lining of the gastrointestinal tract causing severe irritation and even perforation in some cases. Lavage should not be performed in patients as fluid given for lavage can cause fluid overload if kidneys are not working correctly.
How to perform gastric lavage?
A tube is inserted into the stomach distal esophagus or pylorus end of the stomach to ensure that all contents are emptied before removing the line. This tube should be about 30cm in length with 4-8mm diameter. It may have a flange around its tip so that it can be hooked over the finger for easy passage through the pylorus sphincter without causing injury.
Lavage fluid is generally water, but certain medications can also be added to this solution, like syrup of ipecac which stimulates the vomiting center and causes reflex emesis (vomiting). One liter of normal saline or 5% dextrose or isotonic solution is used for lavage.
This will be infused at the rate of 50-100ml/kg body weight. After 3 to 5 minutes, the tube is withdrawn slowly, allowing vomiting. If vomiting does not occur, the patient may be given activated charcoal via a nasogastric tube which helps reduce further absorption of poison in the intestine.
Lavage is repeated every 10-15 minutes until the stomach is empty. If there are signs of perforation or bleeding, covering lavage tube with moist gauze dressing may prevent the passage of gastric content through it. This measure should at least be followed to reduce burn injuries on the skin around the site.
Gastric lavage equipment:
Gastric lavage removes poisons from the stomach that cannot be absorbed into the body. If a person has swallowed poison, do not induce vomiting. Give them water or milk. Milk and water will flush out the venom from your stomach better than vomiting. There are three types of equipment for gastric lavage:
1) Bulb syringe :
this consists of a rubber bulb connected to a tube with a long tip. The tip can be placed down the throat, and you squeeze the rubber bulb, which will empty its contents through the line and into the stomach.
2) Nasogastric tube :
this tube is thin and plastic, around 12cm in length. One end is placed in your nose while another lot is passed down your throat and into your stomach so that you can wash out the contents.
3) Enema :
this is usually used for cleansing the bowel by placing a small amount of fluid in the rectum via a tube.
Bulb Syringe:
This equipment is designed to be a simple, cheap means of venesection and washing out poisons from an unconscious victim’s stomach. The bulb syringe consists of a rubber bulb with a tube attached to it that has a long, thin tip at one end, which can then be placed into the victim’s mouth or nose to allow either gravity or pressure from the operator to let fluids flow from it, ideally washing out any poisons present in an unconscious person’s body.
Nasogastric tube:
The nasogastric (or NG) tube is a device for feeding or draining the stomach. It is usually made of polyurethane or silicone rubber and comes in various sizes; smaller tubes are used for infants, children, and adults with swallowing difficulties, while larger tubes are required for obese individuals. A physician or other health care provider inserts the tube through the nose into the stomach (called nasal gastric intubation).
An adequately inserted nasogastric tube allows the drainage of stomach contents through gravity into an external bag after removing the syringe/feeding cup assembly at the distal end. This will enable continuous air aspiration during insufflation, especially in cases involving substances that may create gastric distention.
Gastric lavage uses:
Gastric lavage removes poisons from the stomach that cannot be absorbed into the body. If a person has swallowed poison, do not induce vomiting. Give them water or milk. Milk and water will flush out the venom from your stomach better than vomiting.
Enema:- this is usually used for cleansing the bowel by placing a small amount of fluid in the rectum via a tube.
Technique for gastric lavage:
1- The bulb syringe should preferably be rinsed with boiled or distilled water before each use, as this significantly reduces the risk of transferring infectious agents through it if different people share it; boiling kills HIV, hepatitis A and B viruses, norovirus, Shigella, Shiga toxin-producing E. coli, campylobacter, cholera, and some other bacteria.
2- The victim should be made to lie on their left side with the right knee drawn up towards the chest. This position makes it easy to insert the tube into the upper end of the stomach.
3- A folded towel is placed under the victim’s head. If available, a rolled handkerchief or something similar may be used in place of a towel.
4- The tip of the tube can be lubricated with water or KY jelly. However, this is not necessary for most patients nor recommended if any mucus, vomitus, blood, or soiling is present at either opening in the body.
5- The tube should then be passed to the stomach entrance, which is about 10–12 cm (4-5 inches) below the left nipple.
6- As the tip enters the mouth or nose, it can be directed so that its opening lies between the back teeth or at the roof of the mouth—just behind the front teeth.
7- Once inserted, if possible, leave it in place for 5 minutes to allow the pressure within the stomach to expel any poison present. After this length of time, check that there are no leaks by blowing through one end of the tube and looking for bubbles emerging from another end. If no bubbles are seen, then proceed with lavage as follows:
8- Stand over the victim’s head, a plastic bag or bowl collected beneath the victim’s nose.
9- The bulb syringe must be held in one hand and firmly squeezed to fill it with half a liter of water, milk, OR saline solution. This is then quickly squirted into the stomach through a tube as follows:
10- Release bulb from your grip and hold the end of hose nearest tip. If using bags instead, ensure that twist tie for the bag is now a place where the hose enters the opening in the bag. It should already have been tied there earlier when preparing for the procedure.
Six indications of gastric lavage:
1- if the victim has ingested hydrocarbon solvent, kerosene, gasoline, or other hydrocarbon products. Hydrocarbon poisoning is common in suicides and fatal poisonings in children because of their curiosity about this colorless liquid that has a pleasant smell.
2- if the victim has ingested camphor oil, naphthalene mothballs, or benzalkonium chloride solution. These are common ingredients in insecticides and germicides. They are also used as disinfectants for rooms where infectious diseases have occurred or still exist.
3- if the victim has ingested solid acids or alkali substances such as sulfuric acid, nitric acid, potassium hydroxide (caustic potash), sodium hydroxide (caustic soda), chlorinated hydrocarbons, or ammonia.
4- if a corrosive substance is suspected, the victim has vomited blood or soiled material that appears to be coffee ground material in color and texture.
5- if the victim has ingested paraquat herbicide, which is now being sold as a weed killer in developing countries or regions that produce their food crops or need to save them from pests. Poisoning occurs because this type of poison cannot be purchased legally anywhere outside those regions, but local people can easily buy it for making bomb detonators.
6- if any person involved with poisoning looks comatose and shows signs of shock such as cold, clammy skin. This may indicate a large volume of poison has been swallowed.