Gastric Lavage, commonly known as “stomach pumping,” is an emergency medical intervention used to clear the stomach contents. Its primary purpose is to quickly remove harmful substances, such as ingested toxins or drug overdoses, before they are fully absorbed into the body’s circulation. This technique involves the sequential administration and removal of fluid through a tube inserted into the stomach. The procedure is performed only when the potential benefits of mitigating poisoning outweigh the risks involved.
Patient Preparation and Medical Context
Gastric lavage is typically performed in acute poisoning scenarios, especially when a life-threatening dose was ingested within the preceding hour. Medical staff prioritize establishing a secure environment due to the urgency and the nature of the toxins. Before the procedure, the patient is often positioned in the left lateral decubitus position (lying on their left side with the head slightly lowered). This posture delays the passage of stomach contents into the small intestine and reduces the risk of aspiration into the lungs.
Airway protection is a serious consideration, particularly if the patient has a decreased level of consciousness or an absent gag reflex. In these cases, a cuffed endotracheal tube is inserted to isolate the airway before the lavage begins, preventing stomach contents from being inhaled. For conscious patients, a topical anesthetic may be sprayed into the throat to minimize the natural gagging response. Sedation can also be administered to reduce distress and promote cooperation, ensuring the procedure is performed safely.
The Steps of Gastric Lavage
The mechanical process begins with selecting a large-bore orogastric tube, typically 36 to 40 French for adults, which is wide enough to retrieve pill fragments. The necessary length is measured externally from the patient’s mouth to the earlobe and then down to the upper abdomen to guide insertion depth. The tube is lubricated with a gel and gently passed through the mouth and down the esophagus into the stomach.
Once the tube is in place, its position must be confirmed, often by injecting air and listening with a stethoscope over the stomach. The initial stomach contents are aspirated for toxicology analysis, and then the washing cycle starts. Small volumes of fluid (usually 200 to 300 mL of warm saline or water for adults) are instilled into the stomach through the tube. This fluid is immediately drained out using gravity or gentle suction, effectively washing the stomach lining. This cycle is repeated until the fluid draining from the stomach returns clear, indicating the bulk of the toxic substance has been removed.
The Physical Sensations During the Procedure
The most intense physical sensation for a conscious patient is the passage of the large tube through the throat and down the esophagus. This triggers a powerful, nearly uncontrollable gag reflex, causing retching and a feeling of choking or pressure. Although insertion is quick, the momentary intrusion is highly distressing and often causes the patient’s eyes to tear up involuntarily.
Once the tube is positioned in the stomach, the discomfort shifts to a constant sensation of foreign material lodged in the throat, maintaining the urge to gag. The patient may feel distinct pressure or fullness in the stomach as the warmed saline or water is instilled during the lavage cycle. This is followed by a strange, often cold sensation as the fluid and stomach contents are quickly suctioned back out.
The procedure is characterized by intense discomfort, though not necessarily pain. Patients are often physically restrained to prevent them from inadvertently pulling the tube out. Medical staff work rapidly, recognizing the experience is profoundly unpleasant, but the active phase of insertion, cycling, and removal is typically completed quickly. After the final wash, the tube is clamped and swiftly withdrawn, which causes a final, brief moment of irritation as it passes through the sensitive upper airway.
Immediate Aftercare and Post-Procedure Monitoring
Immediately following the tube’s removal, patients frequently experience a residual sore throat. If a nasogastric route was used, irritation in the nasal passage may occur. Residual nausea or slight abdominal cramping may also occur as the stomach adjusts to the rapid fluid shifts. In many cases, activated charcoal is administered through the tube before its removal or given orally afterward to absorb any remaining toxins.
Close post-procedure monitoring is required to track the patient’s vital signs and watch for delayed complications. A serious, though rare, concern is aspiration pneumonia, which occurs if stomach contents were inhaled into the lungs during the procedure. Symptoms like fever, persistent coughing, or wheezing prompt immediate investigation for this complication. While recovery from the physical procedure is quick (throat irritation subsides within hours), the patient’s overall recovery focuses on the underlying medical issue that necessitated the lavage.