Gastric Lavage: Stomach Washing Explained

Stomach Washing: A Comprehensive Guide to Gastric Lavage

Stomach washing, medically referred to as gastric lavage, is a procedure that involves the irrigation of the stomach with fluids, typically saline or water, in order to cleanse the stomach of toxins, ingested substances, or harmful material. This technique has been employed for centuries in various medical contexts, primarily as an emergency measure following accidental poisoning or ingestion of toxic substances. In modern medical practice, gastric lavage is used selectively and under controlled conditions due to its associated risks and the advancement of other treatment methods.

The Purpose of Stomach Washing

The primary goal of stomach washing is to remove harmful or potentially life-threatening substances from the stomach before they can be absorbed into the bloodstream and cause significant harm. This procedure is generally performed in cases of poisoning, drug overdose, or the ingestion of non-edible objects or chemicals. Gastric lavage is also used to evacuate the stomach content in situations where immediate detoxification is necessary, such as in cases of poisoning by substances like:

Toxic chemicals (e.g., cleaning agents, industrial chemicals)
Medications (e.g., overdoses of sedatives, narcotics)
Pesticides
Heavy metals (e.g., lead, mercury)
Alcohol poisoning

By performing gastric lavage early after ingestion, medical professionals aim to minimize the absorption of the ingested substance, thus reducing its toxicity. However, the procedure must be performed within a certain window of time after ingestion for it to be effective. Typically, it is most successful when performed within one hour of ingesting the toxic substance.

Indications for Gastric Lavage

Gastric lavage is generally performed only when specific conditions are met, including:

Recent ingestion of a potentially harmful substance: The procedure is typically used when toxic substances have been ingested within the last hour or so. In some cases, it may still be attempted up to four hours after ingestion, though its effectiveness decreases over time.
Symptomatic overdose or poisoning: If the individual shows clear signs of intoxication, such as confusion, vomiting, or even loss of consciousness, gastric lavage may be necessary to prevent further absorption of the toxin.
Severe poisoning cases: Gastric lavage is often used in severe or life-threatening poisoning cases, where the ingested substance poses a significant risk to the patient’s health, especially when other interventions, such as activated charcoal, are not appropriate or sufficient.
When other treatments are unavailable or inappropriate: In some emergency settings, when other detoxification methods such as induced vomiting or activated charcoal are not viable or effective, gastric lavage may be performed as a more direct method of removing toxic substances from the stomach.

Contraindications and Risks

While gastric lavage can be lifesaving in certain situations, it is not without its risks. There are several contraindications to performing gastric lavage, as it may not always be the best course of action. These include:

Ingestion of caustic substances: If the substance ingested is corrosive (such as strong acids or alkalis), performing gastric lavage can cause further damage to the esophagus or stomach lining. In such cases, the procedure can worsen the injury by disturbing the mucosal layers.
Unconscious patients without secure airway management: In unconscious patients who have not been intubated or do not have their airway protected, gastric lavage may cause aspiration (inhaling the stomach contents into the lungs), leading to severe complications like pneumonia or airway obstruction.
Patients with a history of gastrointestinal surgery or bleeding disorders: Gastric lavage can be risky in patients who have had previous abdominal surgeries or those prone to bleeding, as it may exacerbate existing conditions like perforation or internal bleeding.
Severe cardiovascular or respiratory instability: Patients in shock or those experiencing severe cardiovascular or respiratory issues may not tolerate the procedure well, making it inappropriate in some critical care situations.
When the window for effective lavage has passed: As time passes, the effectiveness of gastric lavage diminishes. After four hours, it is usually considered ineffective for most toxins and may pose unnecessary risks without significant benefits.

The Procedure for Gastric Lavage

When gastric lavage is deemed necessary, it is generally performed in a controlled, clinical setting, such as a hospital emergency room, under the supervision of medical professionals. Here is a step-by-step overview of how the procedure is typically carried out:

Initial Assessment and Stabilization: Before performing gastric lavage, the medical team assesses the patient’s overall condition. This includes ensuring that the patient has a secure airway, stabilizing vital signs, and addressing any immediate life-threatening issues such as respiratory distress or circulatory collapse.
Preparation of the Patient: In cases where the patient is conscious, the healthcare team will often administer an analgesic or sedative to minimize discomfort and anxiety. In more critical cases, the patient may be intubated to secure the airway, ensuring that no fluid enters the lungs during the procedure.
Insertion of a Nasogastric Tube (NG tube): A nasogastric tube is inserted through the patient’s nose or mouth and into the stomach. This flexible tube is designed to carry fluids in and out of the stomach during the lavage process.
Irrigation with Fluids: The stomach is flushed with a saline solution, water, or another appropriate fluid. The amount of fluid used depends on the patient’s size and the severity of the poisoning. The fluid is introduced into the stomach, where it mixes with the stomach contents, helping to dilute and flush out any toxic substances.
Aspiration of Stomach Contents: After the stomach has been irrigated, the fluid and stomach contents are aspirated (suctioned) back out of the stomach through the nasogastric tube. This process may be repeated multiple times until the fluid that is aspirated comes out clear, indicating that the stomach has been sufficiently emptied.
Post-Procedure Monitoring: After the procedure, the patient is closely monitored for any signs of complications, such as aspiration pneumonia, electrolyte imbalances, or injury to the gastrointestinal tract. Additional treatments, such as activated charcoal or antidotes, may be administered to further help with the detoxification process.

Alternatives to Gastric Lavage

While gastric lavage has been a standard treatment for acute poisoning for many years, advances in medical science have led to the development of alternative methods that are often considered safer and more effective. Some of these alternatives include:

Activated Charcoal: One of the most commonly used alternatives to gastric lavage, activated charcoal binds to toxins in the stomach and intestines, preventing their absorption into the bloodstream. It is often the first-line treatment for many types of poisoning, particularly when the ingestion occurred within a few hours.
Whole Bowel Irrigation: This method involves the administration of large volumes of a polyethylene glycol solution to flush out the contents of the gastrointestinal tract. It is typically used for ingestions of larger amounts of sustained-release or enteric-coated drugs that are not well absorbed by activated charcoal.
Antidotes: In some poisoning cases, specific antidotes may be available that counteract the toxic effects of certain substances, such as naloxone for opioid overdose or acetylcysteine for acetaminophen toxicity. These antidotes may be used alongside or instead of gastric lavage, depending on the situation.
Supportive Care: In some cases, particularly with non-lethal ingestions or those that are not immediately life-threatening, supportive care may be the best option. This includes measures like intravenous fluids, pain management, and monitoring while the body naturally metabolizes or excretes the toxin.

Conclusion

Gastric lavage remains a vital tool in the emergency treatment of certain types of poisoning, particularly when time is of the essence. However, with the advancement of other treatment methods such as activated charcoal and whole bowel irrigation, its use has become more selective. When performed under appropriate conditions and with careful consideration of the risks, gastric lavage can be a lifesaving intervention in cases of acute poisoning. As always, medical professionals should weigh the potential benefits and risks of the procedure and consider the individual patient’s circumstances before proceeding.