“Getting your stomach pumped,” medically known as gastric lavage, is an emergency medical procedure to remove ingested substances from the stomach. It involves flushing the stomach with fluids and then removing the contents through a tube. This intervention is performed in urgent situations to prevent the absorption of harmful materials into the bloodstream.
When Gastric Lavage is Performed
Gastric lavage is primarily indicated in cases of acute poisoning or drug overdose, particularly when a toxic substance has been recently ingested. The procedure is most effective within one to two hours of ingestion, before significant absorption. Its use has declined due to advancements in other treatments like activated charcoal, which is often a safer and more effective alternative. Gastric lavage is typically considered for life-threatening ingestions where other therapies are ineffective or unavailable, and the substance is not well-adsorbed by activated charcoal.
The procedure is not a universal treatment for all ingestions, as it carries inherent risks. It is generally not advised for corrosive substances like strong acids or alkalis due to the risk of esophageal injury. Similarly, it is usually avoided with hydrocarbons because of the high potential for aspiration. The decision to perform gastric lavage is made after carefully weighing the potential benefits against the risks for each patient.
The Step-by-Step Procedure
Before gastric lavage, patient preparation is important. If the patient has an impaired level of consciousness, their airway is typically protected by intubation with a cuffed endotracheal tube to prevent aspiration of stomach contents into the lungs. The patient is often positioned in a left lateral decubitus position, with their head lowered by about 10-20 degrees; this helps delay gastric emptying and reduces the risk of aspiration.
A large-bore orogastric tube, usually 36-40 French for adults, is lubricated and inserted through the mouth and down the esophagus into the stomach. Tube placement is confirmed by aspirating stomach contents for pH testing, auscultating over the stomach while air is insufflated through the tube, or by X-ray.
Small volumes of fluid, typically 200-300 mL of warm water or normal saline for adults, are instilled into the stomach. For children, normal saline is preferred at a volume of 10-15 mL per kilogram, up to a maximum of 250 mL, to reduce the risk of electrolyte imbalances. After the fluid is instilled, the tube is lowered below the stomach level, allowing the contents to drain out via gravity or gentle suction. This process of instilling and draining fluid is repeated in cycles until the fluid returning from the stomach appears clear.
After the Procedure
After gastric lavage, patient monitoring continues to assess their response and identify any adverse reactions. Vital signs such as heart rate, blood pressure, and oxygen saturation are observed regularly. The patient’s level of consciousness and respiratory status are also evaluated.
Healthcare providers may administer activated charcoal through the lavage tube if indicated for the ingested substance. This helps adsorb any remaining toxins in the gastrointestinal tract. Gastric lavage is often part of a broader treatment plan for poisoning or overdose, which can include specific antidotes, supportive care, and further observation in a medical facility.
Potential Complications
Gastric lavage is an invasive procedure and carries several potential risks. One serious risk is pulmonary aspiration, where stomach contents are inhaled into the lungs, potentially leading to aspiration pneumonia. This risk is heightened in patients with an unprotected airway or those who have ingested hydrocarbons.
Mechanical injuries to the gastrointestinal tract can occur during tube insertion or the lavage process, including damage to the esophagus or stomach, and in rare instances, perforation. Electrolyte imbalances, such as hyponatremia, can develop, particularly in children if water is used instead of saline. Other potential complications include cardiac arrhythmias, laryngospasm, and hypothermia, especially if cold lavage fluid is used.