RECOMMENDED METHOD FOR GASTRIC LAVAGE

NOTE: UNCONSCIOUS PATIENTS HAVE TO BE TREATED WITH SPECIAL CARE. FOR EXAMPLE AN ENDOTRACHEAL TUBE SHOULD BE PLACED PRIOR TO GASTRIC INTUBATION

If the patient has a poor cough reflex, protect the lungs and the patency of the airway by inserting a cuffed endotracheal tube before passing a stomach tube. In conscious patients and even unconscious patients with intact cough and gag reflexes, a large bore stomach tube may be passed at once. Place the patient so that his mouth is lower than his trachea. Remove any dentures and keep the mouth open with a gag. Lubricate the tube with glycerine or a suitable jelly, and ease it over the tongue and down the esophagus to a distance of about 50 cm in adults. Suck out the stomach contents using gentle mechanical suction if available. If a source of continuous suction is not available, a large syringe fitted with an adaptor will help. If little or nothing is obtained, it may be that the tube is not correctly located. Proper positioning of the tube can be checked by forcing a little air down it and listening with a stethoscope over the stomach for bubbling sounds.

After making a reasonable effort to remove any stomach contents and being quite certain that the end of the tube is in the stomach attach a large evacuator or funnel to the oral end of the tube. Add water or physiological saline heated to about body temperature. (300 ml for adults, or less for children). If a funnel is used, elevate the oral end of the tube and allow the water to enter the stomach by gravity. For this purpose, it may be necessary to use an adaptor and add a length of tubing between the funnel and the stomach tube so to increase the overall length and make it easier to regulate the height of the column of water. Before all the water has passed into the stomach, lower the tube into a basin or jar and allow the stomach contents to siphon off, do not use more than 300 ml for each washing, because a large volume would have more tendency to cause emptying of the stomach contents into the duodenum. Repeat the lavage until the returning fluid is clear.

A tube used for evacuating the stomach content must have a rounded, solid end to facilitate passage through the esophagus. If must have at least one large opening in the side just behind the tip and is better if it has several large holes placed at intervals back from the tip. The outer wall must be very smooth. Stomach evacuator tubes commonly sold for use in children have an outside diameter of 7.33 mm (No 22 Charriere scale). Those for adults commonly measure 10 mm (No 30 Charriere scale).

Source: Guidelines for emergency measures in case of pesticide poisoning GCPF

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Pakistan Agricultural Pesticides Association

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