The phrase “getting your stomach pumped” refers to gastric lavage, an emergency medical procedure performed to empty the stomach’s contents. This form of gastrointestinal decontamination involves flushing the stomach with fluid and then removing it to eliminate ingested substances. This technique is typically employed in hospital emergency settings when a person has consumed something potentially harmful or toxic.
Medical Purpose and Indications
The primary medical purpose of gastric lavage is to remove toxic substances from the stomach before they can be absorbed into the bloodstream, preventing severe systemic poisoning. This procedure is considered in acute, life-threatening scenarios, such as an overdose of medications or the ingestion of poisonous chemicals. The goal is to reduce the overall toxic load by physically washing out the stomach contents.
The efficacy of gastric lavage depends heavily on the time elapsed since ingestion. For maximum benefit, the procedure should ideally be performed within 60 minutes, as stomach contents rapidly pass into the small intestine afterward. While its use has declined due to other available treatments, it may still be considered for a massive dose of a substance that delays gastric emptying, such as certain extended-release drugs. The decision to proceed is made by medical toxicologists and emergency personnel on a case-by-case basis.
The Gastric Lavage Procedure
The procedure begins with the patient positioned on their left side, often with the head lowered slightly (the left lateral decubitus position). This positioning helps pool stomach contents and reduces the risk of material passing into the small intestine or being aspirated into the lungs. If the patient has an impaired level of consciousness, a cuffed endotracheal tube is inserted before the procedure to protect the airway from aspiration.
Next, a large-bore, flexible orogastric tube is lubricated and carefully inserted through the mouth and guided down the esophagus into the stomach. The orogastric route is preferred over the nasal route because the tube’s larger diameter (typically 36 to 40 French for adults) is necessary to retrieve whole pills or tablet fragments. Proper placement is confirmed by aspirating a small amount of stomach fluid or by listening over the stomach while injecting a puff of air.
Once the tube is correctly positioned, the lavage cycle begins with the instillation of a small volume of fluid, typically 200 to 300 milliliters of warm normal saline or water for adults. Using small amounts prevents the stomach from becoming overly distended, which could push toxic material further down the digestive tract. The fluid is then immediately removed by gentle suction or by allowing it to drain via gravity. This flushing process is repeated multiple times, often using several liters of fluid in total. The procedure continues until the returning fluid, known as the effluent, appears clear and free of the ingested substance.
Potential Risks and Post-Procedure Care
Gastric lavage is not without risks; the most common serious complication is pulmonary aspiration, where stomach contents enter the lungs, potentially leading to aspiration pneumonia. This risk is higher in patients with a decreased level of consciousness and an unprotected airway. Mechanical injuries are also a concern, including trauma to the esophagus or stomach lining from the large tube, which can rarely lead to perforation or bleeding.
The procedure is contraindicated for individuals who have ingested corrosive substances like strong acids or alkalis, because tube insertion could cause a tear in the already damaged esophagus. Similarly, it is avoided for ingestions of hydrocarbons, such as gasoline or paint thinner, due to the high risk of severe chemical pneumonia if the substance is aspirated. Electrolyte imbalances and hypothermia are also possible complications, particularly if large volumes of cold fluid are used or if the procedure is prolonged.
Following the completion of gastric lavage, the tube is removed, and the patient requires close monitoring of vital signs, including heart rate, blood pressure, and respiratory function. In many cases, activated charcoal is administered through the tube before withdrawal, as this substance binds to residual toxins in the stomach. The patient is then transitioned to definitive medical management, which involves supportive care and treatment for the underlying poisoning or overdose, potentially including a specific antidote.