Gastric Lavage

GASTRIC LAVAGE
Gastric Lavage
•  has been employed widely for some 180 years to
facilitate removal of poisons from the stomach.
•  involves
1.  the passage of an orogastric tube
2.  the sequential administration and aspiration of small
volumes of liquid
•  with the intent of removing toxic substance present in the stomach.
Indications
•  Amount of marker removed by gastric lavage is
ü highly
ü variable and diminishes with time.
•  Studies also have not confirmed the benefit of

gastric lavage alone
o even when it was performed less than 60 minutes after
poison ingestion.
Indications
•  Based on experimental and clinical studies
•  Gastric lavage has little potential benefit
•  Based on severity of potential complication

•  It is a substantial risk.
Indications
•  It is recommended that lavage should not be performed
routinely.
•  In extraordinary situations, the clinician should carefully

examine that risk-benefit ratio
•  weigh it against the use of charcoal alone
•  or observation with supportive care and no gastrointestinal
decontamination.
Contraindication
1.  Gastric lavage is contraindicated if the patient
has an unprotected airway.
•  In a patient with a depressed level of consciousness without
endotracheal intubation
2.  Gastric lavage is also contraindicated if its use

increases the risk and severity of aspiration.
•  For ingestion of hydrocarbon with aspiration potential
Contraindication
•  Patients who
•  are at risk of Hemorrhage
•  are with gastrointestinal perforation due to
pathology
•  Had recent surgery or other medical condition,
could be further compromised by the use of
gastric lavage
Complications of Gavage
1.  Aspiration pneumonia
2.  Laryngospasm
3.  greater rise in the pulse rate
4.  Atrial and ventricular ectopic beats
5.  Perforation of the esophagus and gut
6.  Hypernatremia due to lavage with large quantities of
normal saline
7.  Water intoxication
8.  Small conjunctival hemorrhages
Technique for
Performing Gastric Lavage
1.  If lavage is considered appropriate
•  it is essential that the staff undertaking the procedure
should be experienced in its execution to
•  Gastric lavage is not recommended outside of a health
care facility.
2.  The procedure should be explained to the

patient if conscious and not confused, and
verbal consent obtained.
Technique for
3.  In case of emesis,
it is essential to ensure that a
reliable suction apparatus is available and
functioning.
4.  Endotracheal or nasotracheal intubation should

precede gastric lavage in the comatose patient
without a gag reflex.
5.  An oral airway should be placed between the teeth

to prevent biting of the endotracheal tube if the
patient recovers consciousness or has a
convulsion during the procedure.
Technique for
6.  The patient should be placed in the left lateral/
head down position (tilt on the table).
7.  The length of tube to be inserted is measured and

marked before insertion.
8.  A large bore 36-40 French or 30 English gauge

tube (external diameter approximately 12-13.3 mm)
should be used in adults
9.  24- 28 French gauge (diameter 7.8-9.3 mm) tube in

children.
Technique for
10.  The orogastric tube should be for single-use
only.
11.  The lavage tube should have a rounded end

and be sufficiently firm to be passed into the
stomach via the mouth, yet flexible enough not
to cause any mucosal damage.
12.  The tube should be lubricated with a

hydroxyethylcellulose jelly
Technique for
13.  A nasogastric tube is of insufficient bore may
damage to the nasal mucosa may produce
severe epistaxis.
14.  Force should not be used to pass the tube,

particularly if the patient is struggling.
15.  Once passed, the position of the tube should be

checked either by air insufflation, while listening
over the stomach, and/or by aspiration with pH
testing of the aspirate.
Technique for
16.  Lavage is carried out using small aliquots of liquid.
•  In an adult, 200-300 mL (preferably warm 38C) fluid, such as
normal saline (0.9%) or water, should be used.
•  In a child, warm normal saline (0.9%) 10 mL/kg body weight of
should be given.
17.  The volume of lavage fluid returned should approximate the

amount of fluid administered.
18.  Water should be avoided in young children because of the risk of

inducing hyponatremia and water intoxication.
Technique for
19.  Small volumes are used to minimize the risk of gastric contents
entering the duodenum during lavage, since the amount of fluid
affects the rate of gastric emptying.
20.  Warm fluids avoid the risk of hypothermia in the very young and
very old and those receiving large volumes of lavage fluid.
21.  Lavage should be continued until the recovered lavage solution is

clear of particulate matter.
22.  It should be noted that a negative or poor lavage return does not
rule out a significant ingestion.

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GASTRIC LAVAGE

•  Studies also have not confirmed the benefit of

•  Based on severity of potential complication

•  In extraordinary situations, the clinician should carefully

2.  Gastric lavage is also contraindicated if its use

2.  The procedure should be explained to the

4.  Endotracheal or nasotracheal intubation should

5.  An oral airway should be placed between the teeth

7.  The length of tube to be inserted is measured and

8.  A large bore 36-40 French or 30 English gauge

9.  24- 28 French gauge (diameter 7.8-9.3 mm) tube in

11.  The lavage tube should have a rounded end

12.  The tube should be lubricated with a

14.  Force should not be used to pass the tube,

15.  Once passed, the position of the tube should be

17.  The volume of lavage fluid returned should approximate the

18.  Water should be avoided in young children because of the risk of

21.  Lavage should be continued until the recovered lavage solution is

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GASTRIC LAVAGE

• Studies also have not confirmed the benefit of

• Based on severity of potential complication

• In extraordinary situations, the clinician should carefully

2. Gastric lavage is also contraindicated if its use

2. The procedure should be explained to the

4. Endotracheal or nasotracheal intubation should

5. An oral airway should be placed between the teeth

7. The length of tube to be inserted is measured and

8. A large bore 36-40 French or 30 English gauge

9. 24- 28 French gauge (diameter 7.8-9.3 mm) tube in

11. The lavage tube should have a rounded end

12. The tube should be lubricated with a

14. Force should not be used to pass the tube,

15. Once passed, the position of the tube should be

17. The volume of lavage fluid returned should approximate the

18. Water should be avoided in young children because of the risk of

21. Lavage should be continued until the recovered lavage solution is

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•  Studies also have not confirmed the benefit of

•  Based on severity of potential complication

•  In extraordinary situations, the clinician should carefully

2.  Gastric lavage is also contraindicated if its use

2.  The procedure should be explained to the

4.  Endotracheal or nasotracheal intubation should

5.  An oral airway should be placed between the teeth

7.  The length of tube to be inserted is measured and

8.  A large bore 36-40 French or 30 English gauge

9.  24- 28 French gauge (diameter 7.8-9.3 mm) tube in

11.  The lavage tube should have a rounded end

12.  The tube should be lubricated with a

14.  Force should not be used to pass the tube,

15.  Once passed, the position of the tube should be

17.  The volume of lavage fluid returned should approximate the

18.  Water should be avoided in young children because of the risk of

21.  Lavage should be continued until the recovered lavage solution is