Gastric lavage is one of the decontamination techniques used until today, i.e. removing and deactivating harmful substances from the gastrointestinal tract. It is a procedure that causes quite a lot of discomfort and therefore in some people it is scary, and for young children it can be quite a traumatic experience.

Gastric lavageconsists in repeatedly introducing water into the stomach using a special probe. This water is then removed. The probe can be inserted into the stomach through the nose or through the mouth. The procedure is repeated until the gastric contents to be removed contain only water introduced by the probe.

Gastric lavage - indications

Although gastric lavage may seem harmless to some people, sometimes it can do a lot of harm if the substance ingestion is not carefully interviewed. Gastric lavage in the case of ingestion of a highly toxic substance must be performed within one hour of ingestion.

If we know that you have swallowed drugs with a sustained-release active substance, drugs that slow down the peristalsis of the gastrointestinal tract (for example, anticholinergic drugs), large amounts of a toxic substance, or drugs accumulating in the stomach such as salicylates, this time increases up to four hours.

Except in exceptional circumstances, it is believed that washing the stomach six hours after consuming a given substance does not make sense. A poisoning by toadstool is considered such a situation.

Then the fragments of the fungus are in the stomach even for several to several dozen hours, therefore in this case gastric lavage even after a long time is justified.

According to some sources, gastric lavage is of limited effectiveness and may help to remove only a small part of the ingested substance, but it should be remembered that even this amount may sometimes be a factor in the prognosis of a given patient.

Gastric lavage - contraindications

When it comes to contraindications to gastric lavage, this procedure is never performed after taking corrosive substances (acidic and alkaline), because when ingested, the gastrointestinal wall has already been strongly irritated.

Their re-movement in the same way during gastric lavage could lead toeven for perforation of the gastrointestinal wall.

Gastric lavage should not be performed after taking hydrocarbons or detergents, because these substances, when combined with water, will form foam that may aspirate into the respiratory tract and lead to choking.

Gastric lavage should not be performed in patients with blood coagulation disorders (e.g. in hemophilia, von Willebrand's disease), as this may lead to gastrointestinal bleeding.

Gastric lavage in unconscious persons should be performed only after prior intubation to minimize the risk of aspiration.

How is gastric lavage performed?

Before performing gastric lavage, prepare the necessary equipment, including:

  • appropriate size orogastric or nasogastric tube
  • lidocaine gel
  • syringes
  • isotonic solution of NaCl and water at a temperature close to body temperature
  • Mammals or catheters if necessary to aspirate the contents from the mouth or airways
  • an appropriate vessel to which the gastric contents will be removed, which allows its volume to be measured
  • activated charcoal

Before the procedure, the patient assumes a sitting position, leaning forward.

If we are dealing with a light-headed patient with limited awareness, place him in a lateral position with his head slightly lower.

In the case of the unconscious, as previously mentioned, intubation should be performed first. On the other hand, children, due to their limited cooperation with a doctor, can sit on their parents' lap.

After preparing the necessary equipment, a thick tube, lubricated with lidocaine gel, is inserted into the stomach. Then make sure that the probe is below the cardia of the stomach. This can be checked in several ways:

  • by performing a pumping test and checking for gastric content
  • auscultation of the stomach area while introducing air with a large syringe
  • by taking an x-ray or immersing the tube tip into a water tank (if air bubbles are visible in the water, remove the tube immediately, as it indicates its presence in the respiratory tract)

Then, using a syringe or funnel, the aqueous solution is introduced into the stomach through the gavage in portions, but before introducing the entire portion of water, the funnel (or syringe) should be lowered below the stomach level, which will allow the return of gastric contents.

Repeat this operation until the reflux content contains only the injected water. According to some authors, activated charcoal can be added to the last portion of the introduced solution.

In adults, the size of one portion of the solution is about 200-300 milliliters, while in children it is about 10 milliliters per kilogram of body weight. Remember to monitor the volume of introduced and discharged fluids on an ongoing basis.

What are the complications of gastric lavage?

Gastric lavage, like any medical procedure, may have some complications. However, it should be remembered that scrupulous observance of the above rules can significantly minimize this risk. Possible complications of gastric lavage include:

  • aspiration pneumonia caused by aspiration of gastric contents into the respiratory tract
  • pneumonia caused by inserting a tube into the respiratory tract
  • mechanical damage to the digestive tract, which may result in bleeding or perforation
  • water and electrolyte disturbances
  • heart rhythm disturbance
  • hypothermia caused by administering fluids colder than 37 degrees Celsius
  • laryngospasm that may result in hypoxemia

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