A procedure that removes harmful substances from the stomach by inserting a tube through the mouth or nose. It is performed only for appropriate timing and substance groups.
Indication
- Within the first hour after a life-threatening drug or chemical ingestion
- Ingestion of highly toxic substances in a conscious patient with secured airway
- In poisonings not bound by activated charcoal
- Suspicion of obstructive amounts of medication intake (e.g., slow-release formulations)
- Diagnostic evaluation of upper gastrointestinal bleeding (selected cases)
Preparation
- Detailed patient history: substance taken, amount, time, and accompanying alcohol/medications
- Airway safety is assessed; if consciousness is impaired, intubation is planned first
- Intravenous access is established and monitoring is started
- A wide-bore orogastric tube (36-40 French in adults) and warm normal saline at appropriate temperature are prepared
How it's performed
- The patient is positioned in left lateral decubitus with the head 15-20 degrees down
- The orogastric tube is inserted through the mouth into the stomach; placement is confirmed by air insufflation with auscultation or by pH measurement
- Stomach contents are first aspirated and saved for toxicology
- 200-300 ml of warm normal saline is instilled at a time and then withdrawn; the cycle is repeated until the fluid clears
- If indicated, activated charcoal is administered after lavage
- The tube is carefully removed; total fluid in and out is recorded
Post-procedure
- Airway, consciousness, blood pressure, and ECG are continuously monitored
- Antidotes and supportive care are arranged according to toxicology results
- Respiration is closely monitored due to aspiration risk
- Psychiatric consultation is planned in cases of suspected suicide attempt
- Reassessment and counseling are provided before discharge
Risks
- Aspiration pneumonia (stomach contents entering the lungs)
- Esophageal or gastric perforation
- Laryngeal spasm, airway obstruction
- Arrhythmia, blood pressure changes
- Electrolyte disturbances
FAQ
Is gastric lavage performed in every poisoning?
No. In ingestion of corrosives (acids, alkalis) and petroleum products (gasoline, kerosene), gastric lavage is CONTRAINDICATED due to the risk of perforation or aspiration into the lungs.
Within how many hours is it effective?
It provides the most benefit within the first hour. Beyond this period it is generally not performed; activated charcoal and supportive care are preferred instead.
How does the procedure feel?
During tube placement, gagging and discomfort may be felt. After the procedure, mild throat irritation may persist.
Is it performed in children?
It is used much more selectively in children; the decision is made by a pediatric emergency or toxicology specialist considering age, substance, and time.
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