“Stomach pumping,” formally known as gastric lavage, is an emergency medical procedure used to remove toxic substances from the stomach. This intervention is reserved for acute, life-threatening poisoning cases where a large amount of a toxic substance has been recently swallowed. While its use has become much less frequent in modern medicine, it remains an option when immediate action is necessary to halt the absorption of a lethal dose.
The Actual Duration of Gastric Lavage
The active washing phase of gastric lavage typically takes between 30 and 60 minutes from tube insertion until completion. The goal is to flush the stomach repeatedly until the return fluid, known as the effluent, runs clear.
The active clock starts after the medical team has prepared the patient and secured the airway, which can take additional time. The overall time the patient spends in the emergency department for decontamination is significantly longer than the lavage itself, as the 30- to 60-minute window only accounts for the cycles of fluid exchange within the stomach.
Step-by-Step Process of Stomach Pumping
The procedure begins with careful patient positioning. If the patient has an impaired consciousness level, a cuffed endotracheal tube is first placed to protect the airway from potential aspiration. A large-bore orogastric tube is then measured externally and gently advanced through the mouth into the stomach.
Once the tube placement is confirmed, often by aspirating stomach contents or injecting air while listening over the abdomen, the washing cycles begin. The medical team instills a small volume of pre-warmed fluid, such as normal saline (generally 200 to 300 milliliters for adults), into the stomach. This fluid is then drained via gravity or gentle suction, collecting the toxic contents. This process is repeated until the fluid returning from the stomach is visually clear, indicating that most of the accessible material has been removed.
Factors Influencing the Total Clinical Timeline
While the lavage itself may take less than an hour, the total time a patient spends in the hospital due to toxic ingestion is much more extensive. The most significant initial factor is the need for patient stabilization and preparation, which often includes securing the airway through intubation before the lavage can safely begin. Unstable patients require continuous monitoring and support before, during, and after the procedure.
Factors Extending the Timeline
The nature of the ingested substance influences the total timeline, as materials like sustained-release medications or those that form a concretion require more prolonged washing to break them down and remove them. If complications arise, such as mechanical injury or aspiration, the procedure is halted, immediately extending the timeline due to the need for complication management. Mandatory post-procedure observation is also a major factor, requiring patients to undergo several hours or even days of monitoring to ensure the poison’s effects are fully managed and no delayed toxicity occurs.
Current Clinical Use and Alternatives
Gastric lavage is rarely performed today due to the risk of complications and the lack of strong evidence proving its benefit over other methods. Clinical guidelines reserve the procedure for life-threatening ingestions of toxic substances, and only if it can be performed within approximately 60 minutes of ingestion. If the substance has already left the stomach, the procedure offers little benefit.
For many poisonings, less invasive or more effective alternatives are preferred. Activated charcoal is the most common alternative, binding to many toxins in the gastrointestinal tract and preventing their absorption into the bloodstream. Whole bowel irrigation involves administering large volumes of a polyethylene glycol solution to rapidly flush the entire gastrointestinal tract, preferred for materials not bound by charcoal or for drug packets. A consultation with a clinical toxicologist is recommended to weigh the risks of gastric lavage against the benefits of these decontamination techniques.