II. Precautions
- Gastric Lavage should not be used routinely (if at all) in Poisonings
- In rare cases, when indicated, it should only be used by those trained in proper technique
III. Indications
- Rarely indicated in modern emergency medicine
- Poor efficacy
- Significant Nasal Trauma from large bore tubes (36-40 french Ewald tubes)
- Consider in Overdoses that approach 100% mortality (consult poison control)
- Colchicine Overdose
- Paraquat Poisoning (herbacide typically used outside the U.S., although some pockets of rural U.S. use)
- Hydrofluoric Acid (lethal Hyperkalemia and Hypocalcemia)
- Swaminathan and Nordt in Herbert (2018) EM:Rap 18(5):10-11
- Historically used in severe ingestion cases
IV. Contraindications
- Insignificant Overdose
- Corrosive Ingestion (strong acid or alkali)
- Hydrocarbon Ingestion (high aspiration risk)
- Minimally effective if given >1 hour post-ingestion
- Increased risk of Gastrointestinal Bleeding or perforation
- Unprotected airway (e.g. Altered Level of Consciousness)
V. Complications
-
Aspiration Pneumonia
- Endotracheal Intubation is performed in most patients
- Laryngeal Trauma
- Esophageal Perforation
- Epistaxis (Nasogastric Tubes)
- Electrolyte imbalance
- Hypothermia
VI. Preparations
-
Activated Charcoal
- Activated Charcoal in aqueous solution (preferred due to lower Emesis, aspiration risk)
- Activated Charcoal in Sorbitol
- Lavage Systems
- Consider closed Gastric Lavage systems that allow for large volume lavages in a short period
- Lavage systems are inexpensive (e.g. Eas Lav Kit, Tum-E Vac Kit)
VII. Technique
-
Endotracheal Intubation is performed in most cases before Gastric Lavage
- Secure airway is required for lavage (high risk of aspiration)
- Use a large bore Decontamination tube
- Orogastric Tube: 32 French (preferred)
- Use Laryngoscope to place to avoid Laryngeal Trauma
- Nasogastric Tube: 28 French Ewald tube
- Larger tubes however cause considerable Nasal Trauma
- Orogastric Tube: 32 French (preferred)
- XRay to confirm placement
- Do NOT perform Gastric Lavage before confirming Decontamination tube placement
- Position patient
- Left lateral decubitus position
- Technique
- Aspirate first prior to fluid lavage
- Instill lavage fluid into Stomach
- Adult 100-300 cc warm water or Normal Saline per wash
- Child 10-15 cc/kg warm Normal Saline per wash
- Aspirate fluid back and dispose of fluid
- Repeat lavage
- Repeat until aspirate clears of pill fragments and similar debris of concern
- After completing lavage
- Instill Activated Charcoal
VIII. References
- Swaminathan and Weingart (2025) Gastric Decontamination, EM:Rap, 9/18/2025
- Vale (2004) J Toxicol Clin Toxicol 42(7): 933-43 [PubMed]