What is Gastric Lavage?
Gastric lavage, also known as stomach pumping or gastric irrigation, is a medical procedure used to remove the contents of the stomach. This technique is often employed in cases of acute poisoning or overdose to prevent the absorption of toxic substances into the bloodstream.
When is Gastric Lavage Indicated?
Gastric lavage is generally indicated in specific situations, such as:
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Ingestion of toxic substances that are known to be dangerous if absorbed.
- Cases where activated charcoal is either contraindicated or expected to be ineffective.
- Situations where the patient presents within a short time frame (usually within one hour) of ingesting the poison.
Contraindications
While gastric lavage can be life-saving, it is not suitable for all patients. Contraindications include:
- Caustic substance ingestion (e.g., strong acids or bases) that could cause further damage to the esophagus or stomach lining.
- Patients with a compromised airway, unless the airway is protected with an endotracheal tube.
- Instances of ingestion of hydrocarbons (e.g., gasoline, kerosene), where the risk of aspiration pneumonia is high.Procedure
The procedure involves the insertion of a large-bore nasogastric or orogastric tube into the stomach. The steps are as follows:
1. Patient Preparation: Ensure the patient is in a stable condition and has a secured airway.
2. Tube Insertion: A lubricated tube is gently passed through the nose or mouth into the stomach.
3. Fluid Administration: Small aliquots of saline or water are introduced into the stomach, followed by aspiration to remove the stomach contents.
4. Repetition: This process is repeated until the aspirated fluid is clear of toxic substances.Risks and Complications
Although generally safe when performed correctly, gastric lavage has potential risks and complications, including:
- Aspiration pneumonia: If the contents of the stomach are aspirated into the lungs.
- Esophageal or gastric perforation: Particularly in patients with pre-existing conditions or when the procedure is performed forcefully.
- Electrolyte imbalances: Due to the repeated infusion and removal of fluids.Alternatives to Gastric Lavage
In cases where gastric lavage is contraindicated or not feasible, other decontamination methods may be considered, such as:
- Activated charcoal: Which binds to toxins in the gastrointestinal tract, reducing their absorption.
- Whole bowel irrigation: Using solutions like polyethylene glycol to flush out the entire gastrointestinal tract.
- Induced emesis: Though less commonly used, agents like ipecac syrup may be administered to induce vomiting.Effectiveness
The effectiveness of gastric lavage in reducing morbidity and mortality from poisoning is a topic of ongoing debate. It is generally agreed that the procedure is most effective when performed within one hour of ingestion. However, beyond this time frame, the benefits are less clear and must be weighed against the risks and potential complications.Conclusion
Gastric lavage remains a critical tool in the management of acute poisoning, particularly when used appropriately and within the correct time window. It is essential for healthcare professionals to be aware of the indications, contraindications, and potential risks associated with this procedure to ensure it is used safely and effectively.
