GASTRIC LAVAGE (Stomach Pumping, Gastric Irrigation, or Forced Emesis)

- From the old French word laver meaning to wah!

- The "roce o# cleaning o$t the content o# the tomach!
- An alternative #or lavage i the oral adminitration o# activated car%on& a
form of carbon with a large surface area for binding poisons,
preventing absorption by the gastrointestinal tract.
- Based on eperimental and clinical studies gastric lavage should not
be performed routinely. !recent ingestion of a toic substance".
#avage should only be considered if the amount of poison ingested is
potentially life$threatening and the procedure can be performed
within %& minutes of ingestion.
- 'uring gastric lavage, the patient is positioned on the left side(left
lateral position which allows the gastric contents to pool and
decreases the passage of fluid into the duodenum !first part of the
small intestine" during lavage.
Indication)
Remove $na%or%ed "oion'dr$g a#ter ingetion !only within %& mins of
ingestion".
(iagnoi and to" gatric hemorrhage!
Clean tomach %e#ore diagnotic "roced$re!
Remove li)$id or tomach content %e#ore $rger*!
E*uipments)
- +GT (naogatric t$%e)& water ol$%le l$%ricant& glove
- Lavage #l$id , +acl or other "recri%ed ol$tion' a""ro"riate antidote
(Sodi$m %icar%onate ol$tion& activated charcoal)!
- S*ringe -.ml #or a"iration and /.ml (ae"to *ringe) #or lavage!
- Container
+ontraindications)
- Ingetion o# corroive $%tance (,cids $ sulfuric acid, nitric acid,
hydrochloric acid or muriatic acid, battery acids, Bases - Sodium
hydroide, Potassium hydroide
,l.aline - toilet bowl cleaners, bleach)! , corrosive substance is one
that will destroy and damage other substances with which it comes
into contact.
- Eo"hageal (ieae , GER(& eo"hageal cancer
- Patients with high ris. of hemorrhage due to pathology, recent
surgery, or other medical condition such as a coagulopathy.
- +ompromised(unprotected airway !+onsider Endotracheal
Intubation in advance"
+omplications)
,spiration Pneumonia $ in some patients this may be due to
performing the procedure when the airway is unprotected.
Lar*ngeal tra$ma
Eo"hageal 0er#oration
Epistais - if without lubricant
Fluid / Electrolyte imbalance $ particularly in children lavaged with
water instead of saline, has also been reported.
0ypothermia - ice water lavaged
1asogastric tubes come in vario$ i1e (2& 3.& 3-& 34& 35 and 32 Fr)!
2erifying correct intragastric positioning
The intragatric "oition o# the t$%e m$t %e con#irmed a#ter it initial inertion& and
thi m$t %e doc$mented! There are two wa* o# con#irming the t$%e6 "oition
c$rrentl* recommended! Thee are %* "7 tet (Stoc8 et al& -..29 +0SA& -../a9
-../%) and :;ra*! <ther method can %e inacc$rate and ho$ld not %e $ed!
p0 test
The +G t$%e i a"irated and the content are chec8ed $ing "7 "a"er& not litm$
"a"er (Earle*& -../)! The +0SA (-../%) recommended that it i a#e to #eed
"atient (in#ant& children and ad$lt) i# the "7 i /!/ or %elow! Thi advice doe not
a""l* to neonate ("reterm to -2 da*)! See the +0SA6 (-../%) advice and the
$"date (-..=) #or more in#ormation!
+ote that ta8ing "roton "$m" inhi%itor or 7- rece"tor antagonit ma* alter the
"7! Similarl*& inta8e o# mil8 can ne$tralie the acid!
+hest 3$ray
>hen in do$%t& it i %et "ractice to $e :;ra* to chec8 the t$%e6 location (Stoc8 et
al& -..2)! 0atient who have wallowing "ro%lem& con#$ed "atient and thoe in
IC? ho$ld all %e given an :;ra* to veri#* the t$%e6 intragatric "oition! Thi
involve ta8ing a chet :;ra* incl$ding the $""er hal# o# the a%domen! The ti" o#
the t$%e can %e een a a white radio;o"a)$e line and ho$ld %e %elow the
dia"hragm on the le#t ide!
Syringe test
Thi tet i mentioned here #or hitoric interet onl*! Alo 8nown a the whooh
tet& it ha %een hown to %e an $nrelia%le method o# chec8ing t$%e "lacement& and
the +0SA (-..=9 -../a9 -../%) ha aid that it m$t no longer %e $ed!

Con#irming "oition
Correct intragatric "oitioning ho$ld %e con#irmed@
Immediatel* a#ter initial "lacement9
Ae#ore each #eed9
Following vomiting'co$ghing and a#ter o%erving decreaed oB*gen
at$ration9
I# the t$%e i accidentall* dilodged or the "atient com"lain o# dicom#ort!
+ever inert the g$ide wire while the naogatric t$%e i in the "atient!