Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach using a tube. Since its first recorded use in early 19th century, it has become one of the most routine means of eliminating poisons from the stomach.[1] Such devices are normally used on a person who has ingested a poison or overdosed on a 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.[2] It may play a role in the evaluation of hematemesis. It can also be used as a cooling technique for hyperthermic patients.[3]
Gastric lavage involves the passage of a tube (such as an Ewald tube) 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, 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 intubated before performing lavage. The person must be anaesthetised for a period of time during the operation due to its high risk of shock and hyponatremia.
Indicationsedit
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.[4] 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.[5] 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 rises above 40 °C, gastric lavage with iced saline also can be an aggressive cooling measure in a medical emergency.
Contraindicationsedit
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) (T54), hydrocarbons (T53), or for poisons that have an effective antidote. It is also contraindicated in case of aluminum phosphide poisoning.[6]
^"Latest British Extracts". Sydney Gazette and New South Wales Advertiser. 17 February 1825.
^Gary R. Fleisher; Stephen Ludwig; Benjamin K. Silverman (2002). Synopsis of pediatric emergency medicine. Lippincott Williams & Wilkins. pp. 409–. ISBN978-0-7817-3274-1. Retrieved 4 August 2010.
^Laura W Kates; Erik D Schraga (12 December 2008). "Cooling Techniques for Hyperthermia: Treatment & Medication". eMedicine. Omaha, Nebraska, USA: Medscape. p. 2. Retrieved 3 Nov 2010.
^Vale, JA; Kulig, K; American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists (2004). "Position paper: gastric lavage". J Toxicol Clin Toxicol. 42 (7): 933–943. doi:10.1081/CLT-200045006. PMID 15641639. S2CID 29957973.
gastric, lavage, also, commonly, called, stomach, pumping, gastric, irrigation, process, cleaning, contents, stomach, using, tube, since, first, recorded, early, 19th, century, become, most, routine, means, eliminating, poisons, from, stomach, such, devices, n. Gastric lavage also commonly called stomach pumping or gastric irrigation is the process of cleaning out the contents of the stomach using a tube Since its first recorded use in early 19th century it has become one of the most routine means of eliminating poisons from the stomach 1 Such devices are normally used on a person who has ingested a poison or overdosed on a 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 2 It may play a role in the evaluation of hematemesis It can also be used as a cooling technique for hyperthermic patients 3 Contents 1 Technique 1 1 Indications 1 2 Contraindications 2 Complications 3 References 4 External linksTechnique editGastric lavage involves the passage of a tube such as an Ewald tube 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 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 intubated before performing lavage The person must be anaesthetised for a period of time during the operation due to its high risk of shock and hyponatremia Indications edit 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 4 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 5 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 rises above 40 C gastric lavage with iced saline also can be an aggressive cooling measure in a medical emergency Contraindications edit 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 T54 hydrocarbons T53 or for poisons that have an effective antidote It is also contraindicated in case of aluminum phosphide poisoning 6 Complications editMany 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 bradycardia epistaxis hyponatremia hypochloremia water intoxication or mechanical injury to the stomach References edit Latest British Extracts Sydney Gazette and New South Wales Advertiser 17 February 1825 Gary R Fleisher Stephen Ludwig Benjamin K Silverman 2002 Synopsis of pediatric emergency medicine Lippincott Williams amp Wilkins pp 409 ISBN 978 0 7817 3274 1 Retrieved 4 August 2010 Laura W Kates Erik D Schraga 12 December 2008 Cooling Techniques for Hyperthermia Treatment amp Medication eMedicine Omaha Nebraska USA Medscape p 2 Retrieved 3 Nov 2010 Vale JA Kulig K American Academy of Clinical Toxicology European Association of Poisons Centres and Clinical Toxicologists 2004 Position paper gastric lavage J Toxicol Clin Toxicol 42 7 933 943 doi 10 1081 CLT 200045006 PMID 15641639 S2CID 29957973 BestBets Method of gut decontamination Principle of FMT Rajesh BardaleExternal links editNIH Medline Retrieved from https en wikipedia org w index php title Gastric lavage amp oldid 1168477443, wikipedia, wiki, book, books, library,
