gastric decontamination

1. Dr M.G.Reddy MD
(P.G) Emergency

2.  Gastric lavage is a method of gastrointestinal
decontamination.
 Performed in the setting of an ingested
overdose or acute poisoning, to decrease the
absorption of substances in the stomach.
 This technique was first described in 1812.

3.  Gastric lavage also commonly called stomach
wash or gastric suction, is the process of
cleaning out of the contents of the stomach.
It has been used for eliminating poisons from
the stomach.

4.  For urgent removal of ingested substance to
decrease systemic absorption.
 To empty the stomach before endoscopic
procedure.
 To diagnose gastric hemorrhage and to arrest
hemorrhage.

5.  Gastric lavage is indicated to empty the
stomach immediately, within 1 to 2 hours
after an orally ingested overdose or poisoning
and when not contraindicated
 should be considered where there is evidence
or risk of significant

6.  Evident or high risk of morbidity or mortality:
Beta-blockers
Calcium channel blockers
Chloroquine
Cyanide
Heavy metals
antidepressants
Paraquat
OPC
Phosphorus compound
plant poison

7.  Poor absorption by activated charcoal
Heavy metals
Iron
Lithium
Toxic alcohols

8.  Abnormal or absent pharyngeal/upper
gastrointestinal anatomy
 Active or substantial antecedent vomiting
 Caustic ingestion
 Coagulopathy
 Decreased mental status
 Inactive or diminished airway reflexes

9.  Large pills
 Large or sharp foreign body
 Nontoxic or minimally toxic ingestion
 Signifiant aspiration risk (e.g., hydrocarboné
ingestion)

10.  Equipments
Bowyer's tube
Bite blocker
Lignocaine gelly
Water basine
Normal water
or Oil (generally coconut oil)

11. Ryle’s tube
Stethoscope
Multi-para monitor
Intubation tray
oxygen
Activated charcoal

12.  Make yourself ready
Cap
Glass
Mask
Gown
Gloves
Shoes

13.  Prepare Patient
1.Explain the procedure to pt as well as
relatives
2. Place the patient in the left lateral position
and in 15 to 20 degrees of Trendelenburg

14.  Measuring of tube length
Use the largest diameter orogastric lavage
tube. A size 32 to 36 Fr.
Then measure length of tube from nose to
ear lobe to xiphoid process and marked it.

18.  Insertion of tube
Apply the lignocaine gel on tube for
lubrication

19.  Insert the tube gently upto the marked and
tell the pt to swallow it.

20.  Confirm the tube position

21.  Administer 100 - 300 ml(10 to 15ml/kg bwt) of
lavage fluid via the tube (in children, administer 50
- 100 ml). Then, manually agitate the stomach.
After that, withdraw the fluid.

22.  Repeat this until the lavage return is clear.
Generally, anywhere from 5 to 20 L are
required to thoroughly cleanse the stomach.
 Remember to save the aspirate for toxicology
screening.
 After completion of the lavage, activated
charcoal may be administered via the
orogastric lavage tube.

26.  Aluminium phosphide
 Zink phosphide
 Lavage with oil (generally with coconut oil)

28. Coconut oil has been reported to
inhibit the release of phosphine gas
from aluminium phosphide due to
physicochemical properties of
aluminium phosphide and non
miscibility with fat .

29.  Paraquat poisoning

30. Skin
Remove contaminated clothing / wash skin completely with
soap water followed by repeat body wash Q4th hrly
Eyes
Hair

31. Decontamination
Pay special attention to
Arm pits
Groin
Behind knees
Between toes
Around ears
Eyelids
Inside nose
Inside mouth
Neck creases
ACT093©

33. Cardiac dysrhythmias
Empyema
Esophageal tear or perforation
Gastric perforation
Hypothermia
Laryngospasm

34. Nasal, oral, or pharyngeal injury
Pneumothorax
Pulmonary aspiration
Pyriform sinus perforation
Tracheal placement
Tube impaction

35. Do not use force to remove the lavage tube,
as this may injure or rupture the stomach or
esophagus

37. Charcoal (1g/kg)
First line decontamination method
MDAC- very useful
First dose: 1 g / kg body weight
Subsequent doses: 0.5 g / kg body
weight at 6th hourly up to 48 hours.

40. C- Caustics, Corrosives
H- Heavy metals
A- Alcohol
R- Rapid onset - cyanide
C-Chlorine
O- others ( Iron)
A- aliphatic hydrocarbon
L- lithium

41.  Never with hold intubation if the patient in
distress
 MDAC (RT and Rectal) decreases the need of
antidotes and ICU stay
 If gastric lavage is delaying, charcoal is
indicated don’t delay administer charcoal
 Continue lavage still clear water is returning