The term “stomach pumped” refers to the medical procedure known as gastric lavage, used in emergency settings. This procedure involves mechanically washing out the stomach to remove harmful substances that have been recently ingested. While once a common practice for acute poisoning or overdose, its use has significantly declined in modern medicine due to concerns about effectiveness and the risk of complications. Gastric lavage is now reserved for highly specific and life-threatening situations where the potential benefit is judged to outweigh the considerable risks involved.
When Doctors Decide to Use Gastric Lavage
The decision to perform gastric lavage is made only in rare cases of acute poisoning, specifically when a patient has ingested a potentially lethal dose of a toxic substance. This intervention is time-sensitive, as the greatest efficacy is achieved if the procedure is performed within 60 minutes of the substance being swallowed, before it passes into the small intestine for absorption. The window of opportunity closes rapidly as the material empties from the stomach.
A physician considers gastric lavage when the ingested substance is highly toxic and not effectively bound by activated charcoal, such as iron or lithium salts. It may also be considered for massive overdoses of sustained-release medications, which remain in the stomach for a longer duration. Before proceeding, the medical team weighs the estimated amount of toxin remaining in the stomach against the patient’s current clinical condition and the inherent dangers of the lavage process itself.
The Step-by-Step Procedure
The initial step in gastric lavage involves positioning the patient carefully to minimize the risk of aspiration. The patient is typically placed in the left lateral decubitus position, lying on their left side, with the head lowered about 20 degrees below the feet. This specific positioning helps pool the stomach contents and the lavage fluid away from the pylorus, which reduces the chance of the material passing into the small intestine or being inhaled into the lungs.
Airway protection is paramount, and if the patient has an impaired level of consciousness, a breathing tube with an inflatable cuff is inserted first to secure the airway. A large-bore, lubricated orogastric tube, usually 36 to 40 French in size for an adult, is then gently passed through the mouth and down the esophagus into the stomach. The proper placement of the tube is confirmed by aspirating a small amount of stomach contents or by listening over the abdomen while air is injected through the tube.
Once the tube is positioned correctly, the medical team attempts to aspirate, or suction out, any remaining stomach contents immediately. Next, the actual lavage cycles begin, which involve instilling small aliquots of fluid, typically 200 to 300 milliliters of warmed saline or water, into the stomach. The fluid is then drained out by gravity or gentle suction. This cycle of instillation and aspiration is repeated numerous times, often requiring several liters of fluid, until the drained fluid runs clear and no particulate matter is visible.
Medical Risks of the Procedure
Gastric lavage is an invasive procedure that carries several risks, which is a primary reason its use has been greatly restricted. The most significant danger is pulmonary aspiration, where stomach contents or the lavage fluid are accidentally inhaled into the lungs. This can lead to severe aspiration pneumonitis or pneumonia, a life-threatening complication that occurs when the lungs are injured by the acidic contents or fluid.
The physical act of inserting the large tube can cause trauma or mechanical injury to the upper gastrointestinal tract. This includes potential damage to the throat, esophagus, or even the stomach lining, which may lead to bleeding or, in rare cases, perforation. Furthermore, the large volumes of fluid used during the washing process can disrupt the body’s internal chemistry, potentially causing fluid and electrolyte imbalances, such as low sodium levels (hyponatremia).
Immediate Post-Procedure Management
Once the returning fluid is clear, the procedure transitions to post-lavage care. Before the large tube is removed, a single dose of activated charcoal is often administered directly into the stomach through the tube. This fine, black powder acts as a physical binder, adhering to any residual toxin molecules that the lavage process may have missed, preventing their absorption in the intestines.
Following the administration of the binding agent, the tube is clamped and carefully withdrawn. The patient requires continuous and close monitoring of their vital signs, including heart rate, blood pressure, and breathing, to immediately detect any signs of aspiration or systemic toxicity. Ongoing medical management will then focus on supportive care and specific treatments tailored to the type and amount of substance that was ingested.