Stomach Flushing

Definition

Stomach flushing is the repeated introduction of fluids into the stomach through a nasogastric tube, and their subsequent withdrawal by nasogastric suction.

Purpose

Stomach flushing is performed to aid in controlling gastrointestinal bleeding or to cleanse the stomach of poisons.

Controlling stomach bleeding

Bleeding from the esophagus due to ruptured veins or bleeding from the stomach due to ulcers is a medical emergency. In an attempt to stop the bleeding, the stomach is flushed with large quantities of body-temperature saline solution or ice water. This procedure is called stomach flushing or gastric lavage.

Stomach flushing to control bleeding is not uniformly accepted, and some experts believe it is of little benefit and exposes the patient to unnecessary risks. It is usually done in conjunction with the administration of drugs to constrict the blood vessels.

Stomach flushing to remove poisons

At one time, stomach flushing was common practice to remove certain poisons. Recent thinking by the American Academy of Clinical Toxicology is that stomach flushing should not be used routinely with poisoned patients. It is useful only if the patient has swallowed a life-threatening quantity of poison, and when the flushing can be done within 60 minutes of having swallowed the poison.

Precautions

In poisoning cases, stomach flushing should not be used if the poison is a strong corrosive acid (hydrochloric acid, sulfuric acid), alkali (lye, ammonia), or a volatile hydrocarbon such as gasoline. Stomach flushing should also not be done on patients who are having convulsions. Patients who are losing or have lost consciousness must have their airways intubated before a nasogastric tube is inserted.

Description

Stomach flushing is performed in a hospital emergency room or intensive care unit by an emergency room physician or gastroenterologist. A nasogastric tube is inserted, and small amounts of saline or ice water are introduced into the stomach and withdrawn. The procedure is repeated until the withdrawn fluid is clear.

Preparation

Little preparation is necessary for this procedure other than educating the patient as to what will happen. The patient should remove dental appliances before the nasogastric tube is inserted.

Aftercare

After stomach flushing, the patient's vital signs will be monitored. Checks will be made for fluid and electrolyte imbalances. If necessary, additional treatment to prevent gastrointestinal bleeding or poisoning will be done.

Risks

In poisoning cases, stomach flushing delays the administration of activated charcoal, which may be more beneficial to treating the patient than flushing the stomach. In addition, stomach flushing may stimulate bleeding from the esophagus or stomach. The patient may inhale some of the stomach contents, causing aspiration, pneumonia, or infection in the lungs. Fluid and electrolyte imbalances are more likely to occur in older, sicker patients. Mechanical damage to the throat is more likely in patients who are uncooperative.

Normal results

Stomach flushing is usually tolerated by patients and is a temporary treatment, performed in conjunction with other therapies.

Resources

PERIODICALS

"Gastric Lavage (The AACT/EAPCCT Position Statements on Gastrointestinal Decontamination)." Journal of Toxicology: Clinical Toxicology 35, no. 7 (December 1997): 771.

KEY TERMS

Electrolytes— Salts and minerals that ionize in body fluids. Common human electrolytes are sodium chloride, potassium, calcium, and sodium bicarbonate. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost any major biochemical reaction in the body.

Saline— A salt water solution that mimics the concentration of electrolytes in the blood.