What is the proper procedure for performing gastric lavage?

Gastric Lavage Procedure

Gastric lavage should not be performed routinely for poisoned patients and should only be considered in rare instances of potentially life-threatening poisoning when performed within 60 minutes of ingestion by properly trained personnel. 1, 2

Indications and Contraindications

• Gastric lavage should be limited to extremely serious intoxication cases when the substance has been ingested less than 1-2 hours previously 3
• Contraindicated in patients with unprotected airways unless they are intubated 2
• Contraindicated when hydrocarbons with high aspiration potential or corrosive substances have been ingested 2
• Not recommended for routine use as evidence shows no clear clinical benefit and potential for significant complications 1

Equipment Needed

• Orogastric lavage tube (36-40 French for adults)
• Tap water or 0.9% normal saline solution (both are equally effective as irrigants) 4
• Personal protective equipment (gloves, gown, face shield if splashing anticipated) 5
• Suction equipment
• Collection container for lavage fluid

Procedure Steps

1. Position patient in left lateral decubitus position with head slightly lower than body to prevent aspiration 5

2. Measure the distance from the bridge of the nose to the earlobe and then to the xiphoid process to determine insertion length of the tube 6

3. Lubricate the tube and insert through the mouth into the stomach 6

4. Confirm proper placement by aspirating gastric contents or insufflating air while auscultating over the stomach 6

5. Instill 200-300 mL of lavage fluid (tap water or normal saline) at a time 4

6. Apply gentle suction to withdraw the fluid, or allow it to drain by gravity 6

7. Repeat the instillation and withdrawal process until the returned fluid is clear 6

8. Document the procedure, including any pill fragments or other material retrieved (pill fragments are returned in only about 27% of cases) 7

Potential Complications

• Aspiration occurs in 0.3-1.0% of cases, leading to hypoxia and hypotension 6
• Perforation (complete laceration of the stomach) occurs in 0.5-1.3% of cases 6
• Other complications include laryngospasm, esophageal tears, and cardiac dysrhythmias 1

Management of Complications

• Assess airway, breathing, and circulation immediately if complications occur 6
• If perforation is suspected, obtain immediate surgical consultation 6
• For aspiration, provide respiratory support as needed 6

Special Considerations

• In poisoning cases, activated charcoal is generally preferred over gastric lavage unless the toxin will not bind to charcoal or the amount ingested is too great 3
• Multiple-dose activated charcoal may be considered for toxins that use enterohepatic circulation (theophylline, carbamazepine, quinine, dapsone, phenobarbital) 3
• Whole-bowel irrigation should be limited to ingestion of toxins with sustained release or enteric coating, or for toxins that don't bind to activated charcoal 3

Cleaning and Disinfection of Equipment

• Equipment should be cleaned immediately after use to remove all blood, secretions, and organic material 5
• Soak equipment in suitable neutral or enzymatic detergent 5
• Clean all surfaces carefully, particularly around control sections and connection points 5
• After cleaning, equipment should be disinfected according to manufacturer's instructions 5
• Rinse equipment thoroughly with bacteria-free water to remove all traces of disinfectant 5