Stomach lavage, or gastric lavage, is an emergency measure carried out in the event of acute intoxication after intentional or accidental ingestion of a toxic substance (drug, household product). Often associated in the collective imagination with drug suicide attempts, gastric lavage is in fact less and less used today.

Stomach lavage, or gastric lavage (LG), is an emergency measure performed in acute poisoning. Its purpose is to evacuate toxic substances present inside the stomach before they are digested and cause lesions or alter one of the functions of the body.

Stomach lavage is one of the so-called digestive cleansing methods, alongside:

• induced vomiting;
• adsorption of toxic substances on activated carbon;
• acceleration of intestinal transit.

Gastric lavage is performed in a hospital setting, usually in the emergency room. The prior installation of a “safety” peripheral venous approach is strongly recommended, and the presence of a resuscitation cart is compulsory. Nurses are authorized to perform the procedure but the presence of a doctor is necessary during the procedure. Gastric lavage can be performed on a person who is conscious or has impaired consciousness. In this case, she will then be intubated.

Gastric lavage is based on the principle of communicating vessels, or “siphoning”, in this case between the contents of the stomach and the supply of external fluids.

A probe, called a Faucher tube, is introduced into the mouth, then into the esophagus until it reaches the stomach. The probe is attached to the mouth with tape, then a tulip (jar) is attached to the probe. Lukewarm salt water is then poured into the probe, in small quantities, and the washing liquid is recovered by siphoning, accompanied by epigastric massage. The operation is repeated until the liquid is clear. Large amount of water may be needed (10 to 20 liters).

Oral care is performed at the end of gastric lavage. To supplement gastric lavage, active charcoal can be administered after catheter removal.

Throughout the procedure, the patient’s state of consciousness, heart and respiratory rates are closely monitored.

The surveillance

After gastric lavage, the patient is closely monitored. He is put in a position lying on his side, to avoid vomiting. A chest x-ray, a blood ionogram, an ECG and the temperature are taken.

Digestive function will resume naturally after gastric lavage. 

The risks 

There are different risks to stomach lavage:

• bronchial inhalation is the most serious complication, which can be life-threatening;
• hypertension, tachycardia;
• bradycardia of vagal origin during the introduction of the tube;
• dental or oral lesions.

Stomach lavage can be performed:

• in the event of voluntary acute intoxication, that is to say an attempt at drug suicide (or “voluntary drug intoxication”), or accidental, generally in children;
• in some cases of upper gastrointestinal bleeding, to monitor bleeding activity and facilitate diagnostic endoscopy.

If the gastric lavage was for a long time considered as the reference method for the evacuation of toxic products, it is much less today. A 1992 consensus conference, reinforced by the recommendations of the American Academy Clinicat Toxicology and the European Association of Poison Centers and Clinicat toxicologists, in fact laid down very strict indications for gastric lavage because of its dangers, its low benefit / risk ratio but also its cost (the technique mobilizes staff and takes time). These indications take into account the patient’s state of consciousness, the time elapsed since ingestion and the potential toxicity of the products ingested. Today, gastric lavage is practiced in these rare indications:

• in conscious patients, in the event of ingestion of substances with a high toxic potential for injury (Paraquat, Colchicine, against which activated charcoal has no effect) or in the event of massive intoxication with tricyclic antidepressants, chloroquine, digitalis or theophylline ;
• in patients with altered consciousness, intubated, in intensive care, in the event of ingestion of substances with high toxic potential;
• in patients with altered consciousness, not intubated, after a test with Flumazenil (to detect benzodiazepine intoxication), in the event of ingestion of substances with high toxic potential.

These indications are not formal. In addition, it is now accepted that gastric lavage is, in principle, not useful more than an hour after ingestion of toxic substances, because of its low efficiency after this period of time. In fact, activated charcoal is often preferred over gastric lavage.

Gastric lavage is contraindicated in the following cases:

• poisoning by caustics (bleach for example), hydrocarbons (white spirit, stain remover, diesel), foaming products (dishwashing liquid, washing powder, etc.);
• poisoning with opiates, benzodiazepines;
• altered state of consciousness, unless the patient is intubated with an inflated balloon catheter;
• history of gastric surgery (presence of abdominal scars), progressive gastric ulcer or esophageal varices;
• in case of risk of inhalation, convulsions, loss of protective reflexes of the airways;
• dependent elderly people;
• infant under 6 months;
• precarious hemodynamic conditions.