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gastric lavage

Indications: 1) poisoning (within 60-90 minutes of poison ingestion) - rarely removes clinically significant amount of poison [2] 2) GI bleed - increases likelihood of early endoscopy but not better patient outcomes [3] Contraindications: Caution: - airway protection (endotracheal intubation) must preceed gastric intubation in patients a) without gag reflex b) with ingestion of a CNS depressant Procedure: 1) nasogastric or orogastric tube is placed a) 36-40 French (adults) b) bite blocks are often necessary to prevent biting down on the tube 2) lavage is performed in the left lateral decubitus position, head down if possible 3) the stomach is irrigated with 1 liter of normal saline (or less depending upon capacity), 200-250 mL aliquots [2] 4) the fluid is then suctioned through the nasogastric tube 5) the procedure is repeated until the fluid is clear or it becomes apparent that the fluid will not clear 6) generally requires a minimum of 2 L (adults) [2] 7) charcoal may be administered through the gastric tube Complications: 1) pulmonary aspiration 2) esophageal perforation 3) hypothermia 4) epistaxis 5) perforation of the posterior pharynx, esophagus 6) installation of lavage fluid & charcoal into the lungs 7) hyponatremia in small children given hypotonic lavage fluid 8) gastric biopsy with the newer active pump stems Interpretation: - bilious fluid without blood returned from gastic lavage suggests that the gastric pylorous is open & there is no active upper GI hemorrhage proximal to the ligament of Trietz [4]

Related

gastrointestinal hemorrhage nasogastric tube (NGT) placement (gastric intubation) toxicity; poisoning; overdose

General

emergency medicine lavage

References

  1. Dorland's Medical Dictionary, 23rd ed., WB Saunders, Philadelphia, 1990
  2. Daubert GP, Emergency Medicine, University of California, Davis
  3. Huang ES et al. Impact of nasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc 2011 Nov; 74:971. PMID: 21737077 - Pallin DJ and Saltzman JR. Is nasogastric lavage in patients with acute upper GI bleeding indicated or antiquated? Gastrointest Endosc 2011 Nov; 74:981. PMID: 22032314
  4. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021