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Indications and contraindications for lavage

Gastric lavage may be performed for diagnostic purposes, such as in preparation for an endoscopic examination, to identify a gastric hemorrhage, for treatment following the ingestion of a toxic substance, or for gastrointestinal bleeding. It can be applied continuously or intermittently and is typically performed in an emergency department.

Before beginning, refer to your facility’s policies and procedures for gastric lavage as some require specially trained staff to perform the insertion. Check the provider’s orders for gastric lavage and the solution to be used. It is vitally important to determine the patient’s level of consciousness before inserting the lavage tube. For a patient who is unconscious or does not have a gag reflex, endotracheal intubation is strongly recommended, along with an oral airway to keep the patient from biting on the endotracheal tube.

 

According to the American Association of Clinical Toxicology, gastric lavage should not be used routinely to manage patients who have been poisoned. This agency recommends considering gastric lavage only when the patient has ingested a potentially life-threatening amount of poison and only when lavage can be performed within 60 minutes from the time of ingestion. These recommendations are based on a thorough review of clinical trials that have demonstrated the limited clinical benefit of gastric lavage for treating patients who have been poisoned.

Contraindications for gastric lavage include ingestion of hydrocarbon with a high aspiration potential, ingestion of a corrosive substance such as a strong acid or alkali, or absent airway protective reflexes unless the patient is intubated. Assess relevant diagnostic data such as coagulation studies and verify the patient’s history. Patients at high risk for complications with nasogastric intubation, such as those with a past history of craniofacial surgery or trauma, may require special insertion techniques or equipment (fluoroscopy). Be sure to discuss any contraindications with the provider.

References

American Academy of Clinical Toxicology. (2000). Position statement: Gastric lavage. Retrieved May 31, 2008, from http://www.npis.org

Craven, R. F., & Hirnle, C. J. (2007). Fundamentals of nursing: Human health and function (5th ed.). New York: Lippincott Williams & Wilkins. pp. 1139-1145.

Heard, K. (2006). The changing indications of gastrointestinal decontamination in poisonings. Clinics in Laboratory Medicine, 26, 1-12.

Kowalak, J. P. (Ed.). Lippincott’s nursing procedures (5th ed.). New York: Lippincott Williams & Wilkins. pp. 657-670.

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2008). Brunner & Suddarth’s textbook of medical-surgical nursing (11th ed.). New York: Lippincott Williams & Wilkins. pp. 1174-1181.

Smith, S. F., Duell, D. J., & Martin, B. C. (2008). Clinical nursing skills (7th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. pp. 652-662.