GASTRIC DECONTAMINATION

Dr M.G.Reddy MD(P.G) Emergency

Gastric lavage is a method of gastrointestinal decontamination.

Performed in the setting of an ingested overdose or acute poisoning, to decrease the absorption of substances in the stomach.

This technique was first described in 1812.

INTRODUCTION

Gastric lavage also commonly called stomach wash or gastric suction, is the process of cleaning out of the contents of the stomach. It has been used for eliminating poisons from the stomach.

DEFINITION

For urgent removal of ingested substance to decrease systemic absorption.

To empty the stomach before endoscopic procedure.

To diagnose gastric hemorrhage and to arrest hemorrhage.

PURPOSE

Gastric lavage is indicated to empty the stomach immediately, within 1 to 2 hours after an orally ingested overdose or poisoning and when not contraindicated

should be considered where there is evidence or risk of significant

INDICATION

Evident or high risk of morbidity or mortality:  Beta-blockers Calcium channel blockers Chloroquine  Cyanide Heavy metals antidepressants Paraquat OPC Phosphorus compound plant poison

INDICATION WHEN INGESTED POISON

Poor absorption by activated charcoal Heavy metals Iron Lithium Toxic alcohols

Con……

Abnormal or absent pharyngeal/upper gastrointestinal anatomy

Active or substantial antecedent vomiting Caustic ingestion Coagulopathy Decreased mental status Inactive or diminished airway reflexes

CONTRAINDICATIONS

Large pills Large or sharp foreign body Nontoxic or minimally toxic ingestion Signifiant aspiration risk (e.g., hydrocarboné

ingestion)

Contraindications con…….

Equipments

Bowyer's tube

Bite blocker

Lignocaine gelly

Water basine

Normal water or Oil (generally coconut oil)

PROCEDURE

Ryle’s tube Stethoscope Multi-para monitor Intubation tray oxygen Activated charcoal

Make yourself ready

Cap Glass Mask Gown Gloves Shoes

Technique

Prepare Patient 1.Explain the procedure to pt as well as

relatives 2. Place the patient in the left lateral

position and in 15 to 20 degrees of Trendelenburg

Measuring of tube length

Use the largest diameter orogastric lavage tube. A size 32 to 36 Fr.

Then measure length of tube from nose to ear lobe to xiphoid process and marked it.

Insertion of tube Apply the lignocaine gel on tube for

lubrication

Insert the tube gently upto the marked and tell the pt to swallow it.

Confirm the tube position

Administer 100 - 300 ml(10 to 15ml/kg bwt) of lavage fluid via the tube (in children, administer 50 - 100 ml). Then, manually agitate the stomach. After that, withdraw the fluid.

Repeat this until the lavage return is clear. Generally, anywhere from 5 to 20 L are required to thoroughly cleanse the stomach.

Remember to save the aspirate for toxicology screening.

After completion of the lavage, activated charcoal may be administered via the orogastric lavage tube.

Technique con…..

Aluminium phosphide Zink phosphide Lavage with oil (generally with coconut

oil)

CONTRAIDICATION OF WATER WASH

Gastric lavage with Oil

Coconut oil has been reported to inhibit the release of phosphine gas from aluminium phosphide due to physicochemical properties of aluminium phosphide and non miscibility with fat .

Why coconut oil?

Paraquat poisoning

Contraindication of oxygen

Decontamination Skin

Remove contaminated clothing / wash skin completely with soap water followed by repeat body wash Q4th hrly

EyesHair

Arm pits

Groin

Behind knees

Between toes

Pay special attention to

Around ears

Eyelids

Inside nose

Inside mouth

Neck creases

Decontamination

ACT093©

Cardiac dysrhythmias EmpyemaEsophageal tear or perforationGastric perforationHypothermiaLaryngospasm

Complications

Nasal, oral, or pharyngeal injuryPneumothoraxPulmonary aspirationPyriform sinus perforationTracheal placementTube impaction

Complications con…

Do not use force to remove the lavage tube, as this may injure or rupture the stomach or esophagus

Activated charcoal

Charcoal (1g/kg)

First line decontamination method

MDAC- very useful

First dose: 1 g / kg body weight

Subsequent doses: 0.5 g / kg body

weight at 6th hourly up to 48 hours.

Charcoal dose

C- Caustics, CorrosivesH- Heavy metalsA- AlcoholR- Rapid onset - cyanideC-ChlorineO- others ( Iron)A- aliphatic hydrocarbonL- lithium

Doesn’t adsorb

Never with hold intubation if the patient in distress

MDAC (RT and Rectal) decreases the need of antidotes and ICU stay

If gastric lavage is delaying, charcoal is indicated don’t delay administer charcoal

Continue lavage still clear water is returning

Take home message

THANK YOU