Pharm

Gastric Lavage

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Gastric Lavage, Orogastric Lavage, Stomach Pumping, Gastric Irrigation

  • 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
  • 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. Colchicine Overdose
    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
  • 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)
  • Complications
  1. Aspiration Pneumonia
    1. Endotracheal Intubation is performed in most patients
  2. Laryngeal Trauma
  3. Esophageal Perforation
  4. Epistaxis (Nasogastric Tubes)
  5. Electrolyte imbalance
  6. Hypothermia
  • Preparations
  1. Activated Charcoal
    1. Activated Charcoal in aqueous solution (preferred due to lower Emesis, aspiration risk)
    2. Activated Charcoal in Sorbitol
  2. Lavage Systems
    1. Consider closed Gastric Lavage systems that allow for large volume lavages in a short period
    2. Lavage systems are inexpensive (e.g. Eas Lav Kit, Tum-E Vac Kit)
  • Technique
  1. Endotracheal Intubation is performed in most cases before Gastric Lavage
    1. Secure airway is required for lavage (high risk of aspiration)
  2. Use a large bore Decontamination tube
    1. Orogastric Tube: 32 French (preferred)
      1. Use Laryngoscope to place to avoid Laryngeal Trauma
    2. Nasogastric Tube: 28 French Ewald tube
      1. Larger tubes however cause considerable Nasal Trauma
  3. XRay to confirm placement
    1. Do NOT perform Gastric Lavage before confirming Decontamination tube placement
  4. Position patient
    1. Left lateral decubitus position
  5. 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
  6. Repeat lavage
    1. Repeat until aspirate clears of pill fragments and similar debris of concern
  7. After completing lavage
    1. Instill Activated Charcoal
  • References
  1. Swaminathan and Weingart (2025) Gastric Decontamination, EM:Rap, 9/18/2025
  2. Vale (2004) J Toxicol Clin Toxicol 42(7): 933-43 [PubMed]