Gastric lavage: how does it work and when to do it?
When it comes to gastric lavage, many people associate the treatment with some voluntary event, such as a suicide attempt
While this is one of the reasons why this type of treatment might be performed, it is certainly not the only one.
There are many other reasons for having a gastric lavage, or as it is called in medical terms, a gastroluxis.
But what this type of treatment really consists of, and for what needs it is used, let’s clarify.
What is gastric lavage and what is it used for?
Gastric lavage, or gastroluxis, is a medical technique, a practice, which is used to rid the stomach of toxic substances, whether ingested accidentally or voluntarily.
The term lavage itself indicates the type of treatment, one goes to ‘wash’ the stomach in order to eliminate dangerous substances ingested and following the guidelines drawn up by the Ministry of Health.
Gastric lavage is generally referred to as an emergency practice, but in reality it can also be used to free the stomach if surgery is required.
Regarding the use of gastroluxis in an emergency, there are some conflicting opinions, with some doctors arguing that it must necessarily be performed within an hour of ingesting the noxious substance, while others claim that even after two hours it is still effective.
In reality, much depends on the type of substance and the individual.
What gastric lavage consists of and how it is performed
This is now a fairly common practice and is not difficult to perform.
The patient lies on his or her left side so that the stomach can be emptied and washed well, even in its large curvature, and this position also reduces the risk of the lavage liquid passing into the intestine via the pylorus.
Once the patient is positioned, a two-way naso-gastric tube is inserted and buffer substances are introduced into the stomach: water, milk, or more often saline solution.
If the patient is unconscious, however, intubation is performed and gastric lavage is performed in the supine position.
Probes
The probes used for this procedure are made of transparent material.
They have large lateral orifices at the end, and indicators that show the depth of their insertion.
For an adult, the indicated probes are 30 to 50 French with a length of 120 cm.
The gauge to be used should be the thickest possible.
If the diameter exceeds 1 cm, any solid material can be recovered much more easily.
Once the probes have been introduced, gastric suctioning proceeds.
This step is prior to the insertion of the liquid of course, must be done to reduce the toxic content and must be done before washing as otherwise the toxic content could be pushed into the intestine.
The washing
Once the contents, possibly also solid, have been aspirated from the stomach, the actual gastric lavage takes place.
In the adult, large amounts of liquid are pumped in, a little at a time, about 200 ml.
In the child, on the other hand, the recommended volumes of liquid are 20-50 ml, if under 5 years of age, from 6 to 12 a volume of about 100 ml of liquid can be introduced.
Great care must be taken with the doses, as a smaller amount would be ineffective, and a larger amount would stimulate the passage of fluid through the pylorus.
The injected liquid must be recovered, if the probes are well positioned, by free outflow by gravity, but a very gentle massage of the stomach can also be used.
Washing should be continued until the recovered fluid is completely clear and clear, free of solid residues, if any.
Once the liquid is found to have the above-mentioned characteristics, the washing is continued using another couple of litres of liquid.
Once the lavage has been completed, a balance is taken between the fluids introduced and removed (generally those introduced are always greater) in order to prescribe the best therapy.
The probe should be removed very carefully so as not to damage the mucous membranes.
When should urgent gastric lavage be performed
As we have seen, gastric lavage is performed in cases of voluntary or accidental ingestion of toxic substances. It is often young children who need this treatment.
It is not uncommon for a child who has escaped parental supervision to ingest a harmful substance.
Another case in which gastric lavage must be used is when a person has attempted to take his or her own life by ingesting toxic substances, from barbiturates to drugs and whatnot.
Obviously, before proceeding, one must take a careful history of the patient and possibly understand what type of substance he or she has ingested.
Why it is important to know what the patient has ingested
If one knows the substance ingested before intervening, one can quickly proceed with a much more targeted washout.
Unfortunately, this is not always the case and sometimes, especially in cases of deliberate ingestion of toxic substances and unconsciousness of the patient, figuring out what type of substance has been ingested can be difficult.
Therefore, if one knows the toxic substance, one can have a variable action time depending on the substance: if it is substances that slow down peristalsis, one has a much longer action time.
Contraindications of this practice and when it should not be done
Although it is now a very common practice, the risks of causing a mechanical injury to the stomach, oesophagus and throat do exist.
Moreover, it should never be practised when corrosive agents or caustic substances have been ingested.
It is also negative if surfactants have been ingested.
As for contraindications due to the state of patients, this practice is not recommended in the case of epileptic subjects, even in the case of unconscious patients certain precautions should be taken.
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