Gastric Lavage in Hemorrhage and Overdose

With suspected gastric hemorrhage, gastric lavage can be used for the initial assessment of upper gastrointestinal bleeding to potentially identify the severity of bleeding and clear the stomach of blood and clots. Gastric lavage may improve visualization of the gastric fundus in preparation for endoscopy or endoscopic treatments. In overdose, gastric lavage can be used to evacuate drugs or toxins within 1 hour of ingestion, potentially minimizing the consequences of systemic absorption of drugs or toxins.

PREREQUISITE NURSING KNOWLEDGE

• Gastric lavage is not recommended as a routine procedure in the management of hemorrhage and overdose. Current evidence (Level D*) shows limited improvement in patient outcomes after lavage, and the procedure may contribute to additional complications, including gastric or esophageal perforation, aspiration, laryngospasm, dysrhythmias, hypothermia, fluid and electrolyte abnormalities, and hypoxia.²^,³^,⁵^,^7–10 The risk-benefit ratio of gastric lavage should be considered before the procedure is performed.

• The use of gastric lavage has been found to be of potential benefit in some cases of hemorrhage and overdose. Specific indications for the use of gastric lavage include:

Gastrointestinal (GI) hemorrhage: The patient who has had GI hemorrhage may present with signs and symptoms of volume loss and a decrease in oxygen-carrying capacity. These symptoms include tachypnea, tachycardia, hypotension, orthostatic changes, decreased hemodynamic filling pressures, decreased urine output, pallor, cold and clammy skin, confusion, anxiety, and somnolence. The patient may also show signs of hematemesis, maroon or tarry stools, or hematochezia. Gastric lavage in GI hemorrhage may be helpful in clearing the stomach of blood and clots to facilitate evaluation of the source of bleeding and to improve visualization of the gastric fundus in preparation for endoscopic treatment.⁵^,¹⁰ The presence of bright red blood in the aspirate could be an indicator for the need for urgent enodoscopy.⁵

Overdose: The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists do not recommend the use of gastric lavage in the routine management of poisoned patients because of the limited evidence of improved patient outcomes and potential risks of the procedure.³^,⁹ However, in specific poisoning cases, gastric lavage could be of some benefit (Level D*). Indications include if lavage is initiated in symptomatic patients within 1 hour (60 minutes) of ingestion of a potentially life-threatening amount of highly toxic substance, if the substance slows GI motility, or if the substance is a sustained-release medication.³^,^7–9 Gastric lavage is contraindicated in the use of overdose if the patient has consumed strong corrosives or hydrocarbons (e.g., gasoline, strong acids, or alkali) and if the pills or pill fragments are known to be larger than the opening of the orogastric (OG) tube.⁶^,⁹ The administration of activated charcoal (AC) has been used in combination with gastric lavage for specific toxins; however, its use must be approached cautiously because the combination of therapies may result in an increased risk for aspiration.⁷^,⁸ It should be noted that the end point of gastric lavage is not clearly defined if particulate cannot be clearly observed; however, the amount of lavage fluid instilled should approximate the amount of fluid returned.^7–9 Gastric lavage after overdose or toxin ingestion has variable efficacy. The amount of toxin or drug recovered depends on variables such as time from ingestion, whether liquid or pills were ingested, specific agent ingested, and size of lavage tube used. Even if lavage is performed close to the time of ingestion, not all the ingested toxin will be recovered and treatment related to effects of the overdose will still be necessary.^6–9