Gastric lavage

{{Short description|Process of clearing the stomach contents}} '''Gastric lavage''', also commonly called '''stomach pumping''' or '''gastric washing''' or '''gastric suction''', is the process of cleaning out the contents of the [[stomach]] using a tube. Since its first recorded use in the early 19th century, it has become one of the most routine means of eliminating poisons from the stomach.<ref>{{Cite web|url=http://trove.nla.gov.au/newspaper/article/2183729|title = Latest British Extracts|newspaper = Sydney Gazette and New South Wales Advertiser|date = 17 February 1825}}</ref> Such devices are normally used on a person who has ingested a [[poison]] or [[drug overdose|overdosed]] on a [[psychoactive drug|drug]] such as [[ethanol]]. They may also be used before [[surgery]], to clear the contents of the [[digestive tract]] before it is opened.

Apart from toxicology, gastric lavage (or nasogastric lavage) is sometimes used to confirm levels of bleeding from the upper gastrointestinal tract.<ref name="FleisherLudwig2002">{{cite book|author1=Gary R. Fleisher|author2=Stephen Ludwig|author3=Benjamin K. Silverman|title=Synopsis of pediatric emergency medicine|url=https://books.google.com/books?id=eakFLQfJVl0C&pg=PA409|access-date=4 August 2010|year=2002|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-3274-1|pages=409–}}</ref> It may play a role in the evaluation of [[hematemesis]]. It can also be used as a cooling technique for [[hyperthermia|hyperthermic]] patients.<ref>{{cite web |url=http://emedicine.medscape.com/article/149546-treatment |title=Cooling Techniques for Hyperthermia: Treatment & Medication |author=Laura W Kates |author2=Erik D Schraga |date=12 December 2008 |work=eMedicine |publisher=Medscape |location=Omaha, Nebraska, USA |page=2 |access-date= 3 Nov 2010}}</ref>

==Technique== Gastric lavage involves the passage of a tube (such as an ''Ewald tube'') [[Nasogastric intubation|via the mouth or nose]] down into the stomach followed by sequential administration and removal of small volumes of liquid. The placement of the tube in the stomach must be confirmed by pH testing a small amount of aspirated stomach contents, or x-ray. This is to ensure the tube is not in the lungs.

In adults, small amounts of warm water or saline are administered and, via a siphoning action, removed again. In children, [[Saline (medicine)|normal saline]] is used, as children are more at risk of developing [[hyponatremia]] if lavaged with water. Because of the possibility of vomiting, a suction device is always on hand in case of [[pulmonary aspiration]] of stomach contents. Lavage is repeated until the returning fluid shows no further gastric contents.

If the patient is unconscious or cannot protect their airway then the patient should be [[Intubation|intubated]] before performing lavage.{{according to|date=May 2025}} The person must be anaesthetised for a period of time during the operation due to its high risk of shock and [[hyponatremia]].{{citation needed|date=May 2025}}

===Indications===

Gastric lavage is used infrequently in modern poisoning treatment. Some authorities have actually suggested that it not be used routinely, if ever, in poisoning situations.<ref name="jtoxclintox2004-vale">{{cite journal |last1=Vale |first1=JA |last2=Kulig |first2=K |author3=American Academy of Clinical Toxicology |author-link3=American Academy of Clinical Toxicology |author4=European Association of Poisons Centres and Clinical Toxicologists |year=2004 |title=Position paper: gastric lavage |journal=J Toxicol Clin Toxicol |pmid=15641639 |doi=10.1081/CLT-200045006 |volume=42 |issue=7 |pages=933–943|s2cid=29957973 }}</ref> Lavage should only be considered if the amount of poison ingested is potentially life-threatening and the procedure can be performed within 60 minutes of ingestion.<ref>{{cite web |title=BestBets: Method of gut decontamination |url=http://www.bestbets.org/bets/bet.php?id=975 }}</ref> Lavage is also the initial treatment for [[duodenal atresia]] in newborns, a condition where the small intestine is closed distal to the stomach, causing food and fluid to accumulate in the stomach. When the body temperature [[hyperthermia|rises above 40 °C]], gastric lavage with iced saline also can be an aggressive cooling measure in a [[medical emergency]].

===Contraindications===

Lavage is [[contraindicated]] when patients have a compromised, unprotected airway and in patients at risk of gastrointestinal [[hemorrhage]] or perforation. Relative contraindications include when the poisoning is due to a corrosive substance (strong acids or strong bases) ({{ICD10|T|54||t|51}}), hydrocarbons ({{ICD10|T|53||t|51}}), or for poisons that have an effective [[antidote]].

==Complications==

Many complications have been reported, although it appears serious complications are uncommon. The most dangerous risk is [[aspiration pneumonia]], which is more likely to occur if hydrocarbons are ingested in patients without a protected airway. Other complications include [[laryngospasm]], [[Hypoxia (medical)|hypoxia]], [[bradycardia]], [[epistaxis]], [[hyponatremia]], [[hypochloremia]], [[water intoxication]], or mechanical injury to the stomach.{{citation needed|date=May 2025}}

==References==

==External links== * [https://www.medlineplus.gov/ency/article/003882.htm NIH/Medline]

[[Category:Toxicology treatments]]