GASTRIC LAVAGE
INTRODUCTION
Although the use of “stomach pumps” in animal’s dates to the mid-18 th century, its first use (in
human poisoning) is attributed to physic of Pennsylvania, who in 1812, lavage twins poisoned with
laudanum, prescribed for whooping cough. The lavage fluid was brandy and water.
Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of
cleaning out the contents of the stomach. It has been used for over 200 years as a means of
eliminating poisons from the stomach. Such devices are normally used on a person who has ingested
a poison or overdosed on a drug. They may also be used before surgery, to clear the contents of the
digestive tract before it is opened.
DEFINITION
“Gastric lavage is the aspiration of the stomach contents and washing out of the stomach by means of a
gastric tube.”
“Gastric lavage involves the passage of a tube via the mouth or nose down into the stomach, followed
by sequential administration and removal of small volumes of liquid.”
PURPOSES
1. To remove unabsorbed poison after poison ingestion.
2. To diagnose and treat gastric haemorrhage and for the arrest of haemorrhage.
3. To cleanse the stomach before endoscopic procedure.
4. To remove liquid or small particles of material from the stomach.
INDICATION
Oral poisons
Gastrointestinal bleeding
Meconium aspiration syndrome and meconium induced gastritis.
Suspected congenital tuberculosis
Before endoscopic procedure.
CONTRAINDICATION
Ingestion of corrosive poisons.
Ingestion of most hydrocarbons.
Presence of neurologic symptoms likely to impair normal airway protective mechanism.
Tetanus.
EQUIPMENT
1. Stomach tube (oro-gastric/ryles tube) of appropriate size.
2. Suction machine, syringe or aspiration bulb.
3. Liquid paraffin or Vaseline.
4. Mouth gag
5. Normal saline
PROCEDURE
S STEPS RATIONALE
1. Measure the distance on the tube from the mouth or tip To determine the approximate length of the
of nose to ear lobule to epigastrium and mark the tube tube to be inserted.
with an indecible marking pencil or with a piece of
adhesive tape.
2. Keep the patient in supine position with head slightly To clear the passage and easy insertion
hyperextended and supported from beneath with hand.
3. Smear the tube with liquid paraffin or Vaseline as a It help to minimize the friction between
lubricant. It should not be used in neonates so as to tube and mucosa.
prevent aspiration.
4. Open the patient mouth using a gag, if necessary. If patient is unconscious or disoriented, then
he can bite the tube so to prevent it mouth gag
can be used to open the mouth.
5. Pass the tube over the tongue and toward the back of
the throat (oro-gastric) or through one of the nostrils.
6. Pass gently the tube until the mark on the tube reaches To avoid trauma to the mucosa.
up to lips or anterior nostrils. If the tube meets an
obstruction when introduced about half way to the
mark, it has probably entered the trachea. Sudden
aphonic also indicates tracheal introduction. In such
cases, do not use force but simply remove the tube and
gently repeat the procedure until the tube passes
readily to the mark indicated.
7. Confirm the presence of tube in stomach by pushing Because wrong placement of tube can cause
the air through syringe and auscultating over stomach, chocking or aspiration.
or by placing the other end of tube in glass in glass of
water. Building on expiration indicates placement in
trachea.
8. After confirmation, secure the tube with adhesive tape To prevent displacement or pulling of the tube
applied over face of forehead.
9. Position patient in the left lateral decubitus position or Gastrointestinal reflux is more common in the
in a supine position with the head elevated, depending right than in the left lateral position. Elevation
on age and clinical condition of the patient. of head discourages aspiration of gastric
contents by using gravity to keep fluid down
when lavaging.
10. Remove the gastric contents by use of gentle suction Because forceful aspiration may cause injury.
or syringe or aspiration bulb.
11. After the stomach contents have been removed, Because normal saline minimizes the risk of
perform gastric lavage by normal saline. The use of tap electrolyte imbalance.
water or hypertonic saline should be avoided.
12. Instill 10mL/kg of warmed lavage solution for children Warmed fluids helps to minimize the risk of
younger than 5 years, and 150-200 mL in children hypothermia in young children. To avoid
older than 5 years. Water should not be used in electrolyte imbalance, the volume of lavage
children return should equal the amount of fluids
given. Water if used in children increases the
risk of developing hyponatremia and water
intoxication.
13. Instill fluid at consecutive intervals until the fluid Clear aspirate indicates that particulate matter
aspirate is clear. has been removed.
14. Always ensure to close the tube by pinching while To prevent the spillage of tube contents into
withdrawing it from the stomach. respiratory tract.
COMPLICATIONS
Aspiration pneumonia, secondary to vomiting during the procedure
Laryngospasm with cyanosis
Oesophageal perforation, again, speaks against the use of force.
Trauma and false passage formation
Hypoxia, bradycardia, epistaxis, hyponatremia, hypochloremia, water intoxication, mechanical
injury to stomach.
SPECIAL NOTES
The tube may also be inserted through the nostril.
Do not use excessive force while passing the tube.
Watch out for laryngospasm and bradycardia during the procedure
