Gastric Lavage

Overview

 Gastric lavage is a gastrointestinal decontamination technique that

aims to empty the stomach of toxic substances by the sequential
administration and aspiration of small volumes of fluid via an
orogastric tube.

 previously widely favoured method that has now been all but
abandoned due to lack of evidence of efficacy and risk of
complications.
HISTORICAL PERSPECTIVE
 Gastric lavage was first described in 1822 in London: Jukes’ “exhausting pump” and Bush’s
“gastric exhauster”, primarily used for opium ingestion
 The heyday was in the 1950s and 1960s when gastric lavage was the method of choice for all but
first aid settings, and for almost all significant poisonings. At this time barbiturate poisoning was
rife and most objective studies took place in this context
 Pediatricians led the way in turning from gastric lavage, due to inherent difficulties in performing
the procedure on children
 Position statements from the AACT and their European counterparts in 1994, 2003 and 2013
have, in essence, recommended that procedure be abandoned
 The procedure is still widely performed in developing countries, including India and Sri Lanka,
partly because case fatality rates are higher (10-20% versus 0.5% in the West), other therapeutic
options may be unavailable and because of entrenched dogma
Indication:
 Gastric lavage should be rarely, if ever, performed.
 The amount of toxin removed by gastric lavage is unreliable and
often negligible, especially if performed after the first hour.
 There are few (if any) situations where the expected benefits of
gastric lavage would exceed the risks involved and where
administration of activated charcoal would not be provide equal or
greater efficacy of decontamination.
CONTRAINDICATIONS:
 Initial resuscitation incomplete
 Risk assessment indicates good outcome with supportive
care and antidote therapy alone
 Unprotected airway where there is a decreased level of
consciousness or risk assessment indicates potential for
these complications during the procedure
 Small children
 Corrosive ingestion
 Hydrocarbon ingestion
Complications
 Incomplete decontamination leading to severe intoxication despite
the procedure
 Pulmonary aspiration
 Hypoxia
 Laryngospasm
 Mechanical injury to the gastrointestinal tract
 Water intoxication (especially in children)
 Hypothermia
 Distraction of staff from resuscitation and supportive care priorities