“Pumping your stomach,” medically known as gastric lavage, is a procedure used to remove substances from the stomach. It involves flushing the stomach with fluid and then removing the contents. This medical intervention is typically performed in emergency situations to address acute poisoning or drug overdose. The aim is to prevent harmful substances from being absorbed into the bloodstream.
What Gastric Lavage Entails
Gastric lavage involves inserting a wide-bore orogastric tube through the mouth and into the stomach. The orogastric route is often preferred due to the tube’s larger diameter, which helps in more effective stomach emptying. Tube placement is confirmed through methods like air insufflation while listening to the stomach, pH testing of aspirated contents, or X-ray, ensuring it is not in the lungs.
Once the tube is positioned, small volumes of fluid, typically warm water or saline, are instilled into the stomach. Saline is often preferred to mitigate the risk of electrolyte imbalances. This fluid is then drained or suctioned out, often using a funnel, syringe, or mechanical pump. This process is repeated until the returning fluid appears clear or a specified volume of fluid has been used.
Situations Requiring Gastric Lavage
Gastric lavage is considered in specific, limited circumstances, primarily for life-threatening ingestions of toxic substances. It is most effective when performed soon after ingestion, ideally within 60 minutes, as its efficacy decreases rapidly. This procedure may be indicated for substances known to cause severe toxicity or death if not promptly removed.
The decision to perform gastric lavage also considers whether the ingested substance is not effectively adsorbed by activated charcoal or if delayed gastric emptying is suspected.
Reasons It Might Not Be Used
Gastric lavage is not a routine procedure for all poisonings, and its use has significantly declined. One primary reason is its limited effectiveness, particularly if more than an hour has passed since the ingestion, as much of the substance may have already moved beyond the stomach. Recovered amounts of ingested substances can be highly variable, with as little as 8% recovered after 60 minutes.
The procedure is not recommended for corrosive substances like strong acids or alkalis, or hydrocarbons, due to the increased risk of further injury to the esophagus or stomach, and a high potential for aspiration into the lungs. If a patient has an unprotected airway or a decreased level of consciousness, gastric lavage is contraindicated unless the patient is first intubated to prevent aspiration.
Potential Complications
Despite its potential benefits in specific emergency cases, gastric lavage carries various risks. A significant concern is aspiration pneumonia, which occurs if stomach contents are inhaled into the lungs during the procedure. This risk is elevated in patients with an unprotected airway.
Other potential complications include mechanical injury to the esophagus or stomach, such as perforation caused by the insertion of the tube. Patients may also experience laryngospasm, a sudden spasm of the vocal cords, or cardiac rhythm disturbances. Fluid and electrolyte imbalances can occur, especially if large volumes of non-saline solutions are used.
Beyond Stomach Pumping: Other Treatments for Poisoning
In modern toxicology, several other methods are often preferred over gastric lavage for managing poisoning or overdose. Activated charcoal is a widely used and effective treatment that adsorbs many poisons in the gastrointestinal tract, preventing their absorption into the bloodstream. It is typically administered orally or via a nasogastric tube.
Antidotes are specific substances that counteract the effects of particular poisons or drugs. Examples include naloxone for opioid overdose or acetylcysteine for acetaminophen poisoning. These agents work by various mechanisms, such as binding to the toxin, blocking its effects, or enhancing its elimination. Whole bowel irrigation, which involves flushing the entire gastrointestinal tract with a large volume of an osmotic solution, can be used for substances not adsorbed by charcoal or for sustained-release formulations. Supportive care, including monitoring vital signs and managing symptoms, remains a primary intervention for all poisoned patients.