Gastric lavage, commonly known as “stomach pumping,” is a rapid, emergency medical technique used to empty the stomach’s contents. This procedure involves inserting a large, flexible tube through the mouth or nose and down into the stomach. The primary goal is to quickly remove toxic substances or drugs before they can be fully absorbed into the bloodstream. It is a time-sensitive method of gastrointestinal decontamination performed in a hospital setting.
Why and When Doctors Perform Gastric Lavage
The procedure is primarily indicated for acute, life-threatening ingestions of toxic substances or drug overdoses. It is typically considered only when a potentially lethal amount of a toxic substance has been consumed. For the procedure to effectively reduce systemic toxicity, it must usually be performed within one hour of ingestion. Beyond this initial window, the stomach contents often pass into the small intestine, making the procedure much less useful.
The use of gastric lavage has significantly decreased due to safer alternatives, such as activated charcoal. However, it remains a valuable tool for specific circumstances, particularly for substances not effectively bound by charcoal, like iron tablets or lithium. The procedure may also be necessary if the ingested substance delays normal stomach emptying. The decision to proceed involves carefully calculating the risks of the procedure versus the severity of the poisoning.
Understanding the Physical Sensation During the Procedure
The question of whether “stomach pumping” is painful requires distinguishing between pain and extreme discomfort. True pain related to tissue damage is generally not the primary sensation, as the tube is lubricated and inserted carefully. Instead, the patient experiences intense physical discomfort and profound distress, primarily due to the activation of the gag reflex. Inserting the large tube past the throat triggers a powerful reflex, leading to involuntary retching and a feeling of choking.
To mitigate this discomfort, medical staff use specific interventions. The tube is coated in a lubricating gel, which may contain a topical anesthetic like lidocaine to numb the throat. Patients may also receive conscious sedation, such as intravenous medication, to minimize anxiety and relax the gag reflex muscles. While these measures do not eliminate the sensation of a foreign object, they make the necessary emergency procedure tolerable. The overall feeling is one of pressure, gagging, and anxiety from the underlying medical emergency.
The Step-by-Step Lavage Process
The procedure begins with careful patient positioning, typically in the left lateral decubitus position with the head slightly lowered. This specific stance helps reduce the risk of pulmonary aspiration, which is a major concern if the patient vomits during the tube insertion. A large-bore orogastric tube, commonly between 36 and 40 French for an adult, is then measured externally from the patient’s mouth to the stomach and gently inserted. The oral route is generally preferred over the nasal route for these larger tubes to prevent trauma.
Once the tube is believed to be in the stomach, its correct placement must be confirmed. This is often done by using a syringe to inject a small amount of air while listening with a stethoscope over the upper abdomen. After confirming the tube’s position, the lavage cycle begins by introducing a small volume of fluid, usually 200 to 300 milliliters of warm water or saline solution, into the stomach. This fluid is then allowed to drain back out, carrying the stomach contents with it, via a siphoning action or gentle suction into a collection container.
This process of instilling and draining the fluid, known as the lavage cycle, is repeated multiple times. The medical team continues this washing action until the fluid returning from the stomach runs visibly clear. This clarity indicates that the bulk of the toxic substance has been removed. After the lavage is complete, activated charcoal may be administered through the tube to bind any remaining toxins before the tube is finally removed.