Emergency Medicine Book


Gastric Lavage

Aka: Gastric Lavage, Orogastric Lavage, Stomach Pumping, Gastric Irrigation
  1. Precautions
    1. Gastric Lavage should not be used routinely (if at all) in Poisonings
    2. In rare cases, when indicated, it should only be used by those trained in proper technique
  2. Indications
    1. Rarely indicated in modern emergency medicine
      1. Poor efficacy
      2. Significant Nasal Trauma from large bore tubes (36-40 french Ewald tubes)
    2. Consider in Overdoses that approach 100% mortality (consult poison control)
      1. ColchicineOverdose
      2. Paraquat Poisoning (herbacide typically used outside the U.S., although some pockets of rural U.S. use)
      3. Hydrofluoric Acid (lethal Hyperkalemia and Hypocalcemia)
      4. Swaminathan and Nordt in Herbert (2018) EM:Rap 18(5):10-11
    3. Historically used in severe ingestion cases
      1. Overdose or Ingestion within 1 hour
      2. Extraordinary Overdose with a potentially toxic amount of medication
      3. Specific Overdose after 1 hour
        1. Ingested drug slows peristalsis
          1. Anticholinergics
          2. Opioids (Narcotics)
        2. Ingested drug forms Bezoar
          1. Salicylates
          2. Iron
  3. Contraindications
    1. Insignificant Overdose
    2. Corrosive Ingestion (strong acid or alkali)
    3. Hydrocarbon Ingestion (high aspiration risk)
    4. Minimally effective if given >1 hour post-ingestion
    5. Increased risk of Gastrointestinal Bleeding or perforation
    6. Unprotected airway (e.g. Altered Level of Consciousness)
  4. Complications
    1. Aspiration Pneumonia
    2. Laryngeal Trauma
    3. Esophageal Perforation
    4. Epistaxis
    5. Electrolyte imbalance
    6. Hypothermia
  5. Preparations
    1. Activated Charcoal in aqueous solution (preferred due to lower Emesis, aspiration risk)
    2. Activated Charcoal in Sorbitol
  6. Technique
    1. Consider Endotracheal Intubation in advance
      1. Indicated for neurologic Impairment
    2. Use a large bore tube (28 French Ewald tube)
      1. Larger tubes however cause considerable Nasal Trauma
    3. Position patient
      1. Head down
      2. Left lateral decubitus
    4. Technique
      1. Aspirate first prior to fluid lavage
      2. Instill lavage fluid into Stomach
        1. Adult 100-300 cc warm water or Normal Saline per wash
        2. Child 10-15 cc/kg warm Normal Saline per wash
      3. Aspirate fluid back and dispose of fluid
    5. Repeat lavage
      1. Repeat until aspirate clears of pill fragments and similar debris of concern
      2. Single dose is sufficient in many cases
      3. If repeated, alternate aqueous and Sorbitol charcoal preparations every 2 hours
  7. References
    1. Vale (2004) J Toxicol Clin Toxicol 42(7): 933-43 [PubMed]

Gastric Lavage (C0017134)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D005751
ICD9 96.33
ICD10 14200-00
SnomedCT 182511008, 150500001, 182512001, 43269009, 150501002, 173830003, 255992006, 270899000
English Gastric Irrigation, Gastric Irrigations, Gastric Lavages, Irrigation, Gastric, Irrigations, Gastric, Lavage, Gastric, Lavages, Gastric, stomach lavage, Gastric drainage by stom pump, gastric washing (procedure), gastric washing, gastric lavage, gastric lavages, gastric irrigation, pump stomach, pumped stomach, pumping stomach, stomach pump, stomach pumping, Irrigation of stomach (procedure), Stomach pump (procedure), Irrigation of stomach, Nasogastric irrigation, Gastric lavage, Gastric irrigation, Gastric washout, Pumping stomach out, Stomach washout, Washing out stomach contents, Gastric drainage -stomach pump, Stomach pumped out, Gastric drainage by stomach pump, Gastric drainage by stomach pump (procedure), Gastric lavage (procedure), Nasogastric irrigation (procedure), Stomach pump, (Stomach pump) or (procedure), Irrigation of stomach (procedure) [Ambiguous], Gastric Lavage
Spanish lavado gástrico, irrigación del estómago (procedimiento), drenaje gástrico con bomba (procedimiento), drenaje gástrico con bomba, irrigación del estómago (concepto no activo), irrigación del estómago, irrigación gástrica, irrigación nasogástrica (procedimiento), irrigación nasogástrica, lavado de estómago, lavado gástrico (procedimiento), Lavado gástrico, Irrigación Gástrica, Lavado Gástrico
Swedish Magsköljning
Japanese イセンジョウ, 胃洗, 胃洗浄, 洗浄-胃
Czech žaludeční výplach, Žaludeční laváž, gastrická laváž, laváž žaludku, výplach žaludku
Finnish Mahahuuhtelu
French Lavage de l'estomac, Lavage gastrique
Italian Irrigazione gastrica, Lavaggio gastrico
Polish Płukanie żołądka
Hungarian Gyomormosás
Portuguese Lavagem gástrica, Irrigação Gástrica, Lavagem Gástrica
Dutch maagspoeling, Maagspoeling
German Magenspuelung, Lavage, gastrische, Magenspülung, Spülung, Magen-
Derived from the NIH UMLS (Unified Medical Language System)

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