Introduction and Definition of Gastric Lavage
Gastric lavage, often called stomach pumping or gastric washing, is an emergency procedure used to thoroughly cleanse the stomach contents. It involves passing a large-bore tube through the mouth or nose down into the stomach, instilling measured amounts of fluid, and then siphoning or suctioning the liquid back out. In Nigerian clinical practice, this procedure is most frequently deployed in emergency departments for acute, life-threatening oral poisonings or drug overdoses when the patient presents within a narrow therapeutic window after ingestion.
Indications and Contraindications
Deciding to perform gastric lavage requires a careful evaluation of risks versus benefits. It is not indicated for every poisoning case.
- Indications: Severe, life-threatening ingestion of poisons or drugs, presentation within one hour of ingestion, and removal of non-adsorbed toxins where activated charcoal fails.
- Contraindications: Ingestion of hydrocarbons due to high aspiration pneumonia risk, ingestion of corrosive acids or alkalis that can cause esophageal perforation, unprotected airway in an unconscious patient, and severe bleeding disorders.
Required Equipment and Materials
Gathering complete and functional equipment before starting prevents dangerous delays during an emergency. The nurse must assemble the following items at the bedside:
- Ewald or Large-Bore Orogastric Tube: Allows passage of tablet fragments or thick substances.
- Lavage Fluid: Typically warm isotonic saline or sterile water.
- Funnel or Irrigation Syringes: Used to instill the fluid into the tube.
- Large Basin or Bucket: Collects the returned wash effluent.
- Personal Protective Equipment: Gloves, apron, and face shield to protect against splashes of toxic gastric contents.
- Suction Apparatus: Readily available to clear the airway if vomiting occurs.
Pre-Procedure Assessment and Patient Preparation
Before any tube enters the body, the nurse assesses the patient's level of consciousness, airway stability, and baseline vital signs. If the patient has a depressed gag reflex or is semi-conscious, an endotracheal tube with an inflated cuff must be inserted first by the medical team to protect the airway from aspiration. The nurse explains the procedure if the client is alert, ensures verbal consent where applicable, and positions the patient properly, usually in a left lateral decubitus position with the head lowered slightly to minimize gastric emptying into the duodenum and reduce aspiration risks.
Step-by-Step Procedure for Gastric Lavage
Executing the lavage requires precision and continuous observation of the patient's tolerance.
- Measure and Mark: Estimate the insertion distance from the bridge of the nose to the earlobe, and down to the xiphoid process.
- Lubricate: Apply a water-soluble lubricant to the tip of the tube.
- Insert: Pass the tube gently through the mouth or nose into the stomach.
- Verify Placement: Confirm correct placement by auscultating injected air over the epigastric region or aspirating gastric contents.
- Instill and Siphon: Pour a small, measured volume (usually 150 to 250 mL for adults) of warm fluid into the funnel, allow it to mix, and lower the funnel to siphon the fluid back out into the basin.
- Repeat: Continue washing in cycled aliquots until the return fluid is completely clear and free of particles.
Monitoring and Post-Procedure Nursing Care
Once the lavage fluid runs clear, the tube is gently pinched or folded to prevent fluid leakage into the pharynx and withdrawn smoothly. The nurse provides oral hygiene, cleans the patient's face, and makes them comfortable. Continuous observation is vital because water intoxication or electrolyte imbalances can occur, especially if plain tap water was used instead of normal saline. Vital signs, level of consciousness, and psychological status are tracked closely over the next several hours.
Potential Complications and Nursing Interventions
Gastric lavage is an invasive procedure carrying several inherent risks that demand vigilant nursing surveillance.
- Aspiration Pneumonia: Caused by fluid entering the lungs; managed by immediate suctioning and administering oxygen.
- Mucosal Damage or Perforation: Results from forceful tube insertion; indicated by sudden chest or abdominal pain and bleeding.
- Fluid and Electrolyte Disturbances: Caused by fluid absorption; monitored via lab tests and accurate intake-output charts.
- Cardiac Arrhythmias: Triggered by vagal nerve stimulation during throat and stomach manipulation.