The common phrase “getting your stomach pumped” refers to the emergency medical procedure known by the clinical term Gastric Lavage. This technique is a form of gastrointestinal decontamination used to physically empty the stomach contents in a time-sensitive situation. The primary goal is to remove unabsorbed toxic substances, such as poisons or overdose medications, before they can be fully absorbed into the bloodstream. Because of its invasive nature and potential for complications, Gastric Lavage is only performed in a hospital’s emergency or critical care setting.
Reasons for Gastric Lavage
Doctors consider Gastric Lavage only in the most severe cases of acute toxic ingestion, typically when a massive, potentially lethal amount of a life-threatening substance has been swallowed. Timing is crucial because the procedure’s effectiveness diminishes rapidly once the substance moves past the stomach and into the small intestine. To offer meaningful benefit, it must generally be performed within 60 minutes of ingestion.
Specific indications include highly toxic substances that do not bind well to alternative treatments, such as iron, lithium, or sustained-release drug formulations. The decision to proceed requires carefully weighing the potential benefits of removing the poison against the risks associated with the invasive procedure itself.
How the Procedure is Performed
The Gastric Lavage procedure begins with carefully positioning the patient, often in a left-sided, head-down position. This helps prevent gastric contents from being aspirated into the lungs. If the patient is unconscious or has a reduced level of consciousness, the airway must first be protected, typically by inserting a cuffed endotracheal tube. This step is necessary to guard against the severe risk of aspiration pneumonia, which occurs if stomach contents enter the lungs.
A large-bore, lubricated tube, known as an orogastric tube, is gently passed through the patient’s mouth and down the esophagus until it reaches the stomach. Healthcare providers confirm the tube’s correct placement by aspirating a small amount of stomach contents or by listening over the stomach while injecting air through the tube.
Once the tube is secured, small volumes, usually about 200 to 250 milliliters, of warm water or saline solution are instilled into the stomach. The fluid is then immediately drained out, either using a large syringe for manual aspiration or via gravity into a collection container. This process of flushing and draining is repeated multiple times, effectively “washing” the stomach. The cycle continues until the fluid returning from the stomach, known as the effluent, appears clear, indicating that most of the unabsorbed substance has been removed.
Distinguishing Gastric Lavage from Other Treatments
Gastric Lavage is not the only method of gastrointestinal decontamination. Modern toxicology has largely shifted away from its routine use due to safety concerns and limited evidence of improved outcomes.
The more common and often preferred intervention is the administration of Activated Charcoal, a fine black powder that works by adsorption, binding to many toxins in the gastrointestinal tract and preventing their absorption. Activated charcoal is less invasive and can be effective for a wider range of substances if given early.
Whole Bowel Irrigation
Another distinct method is Whole Bowel Irrigation, which involves administering large volumes of an electrolyte solution, often via a tube, to flush the entire digestive tract. This technique is typically reserved for substances that do not bind to activated charcoal, such as metals, or for drug packets swallowed by body packers. Unlike the localized washing of the stomach performed in gastric lavage, whole bowel irrigation aims to hasten the transit of the toxin through the entire length of the gut.
Immediate Aftermath and Recovery
Once the medical team determines that the lavage is complete, the orogastric tube is gently removed. The patient is then immediately placed under close observation, often in an intensive care setting, for continuous monitoring of their vital signs. The short-term physical consequences of the procedure itself can include a sore throat and mild discomfort from the large tube passing down the throat.
The patient is monitored for potential complications related to the procedure, such as aspiration, esophageal injury, or fluid and electrolyte imbalances. Follow-up care is then focused on managing the effects of the initial poisoning or overdose, which may involve administering an antidote or providing supportive care. Recovery from the underlying toxic ingestion is the primary concern, as the effects of the lavage procedure itself are generally short-lived.