Contraindications to gastric lavage

Gastric lavage is a very important rescue measure. For example, in case of poisoning, gastric lavage is needed to remove the poisons in the stomach that have not been absorbed yet. Although gastric lavage can deal with various poisoning incidents, it also depends on the situation. Some patients, such as those with esophageal varices, are not suitable for gastric lavage. In other words, gastric lavage also has contraindications. Forcible gastric lavage in unsuitable situations may be counterproductive. So, what are the contraindications of gastric lavage?

The purpose of gastric lavage is to remove harmful substances from the stomach. Its indications are as follows:

1. Accidental ingestion of drugs or poisons.

2. The newborn vomits repeatedly after birth, suspected of amniotic fluid aspiration.

3. Complete and incomplete pyloric obstruction.

4. Acute and chronic gastric dilatation.

5. After barium meal angiography in infants, prevent accidental inhalation of barium during vomiting. Medical Education Network search and compilation

Contraindications

1. If you take corrosive drugs such as strong acids or alkalis, do not perform gastric lavage to avoid gastric perforation.

2. Gastric lavage is contraindicated in patients with esophageal or cardia stenosis or obstruction, aortic arch aneurysm, recent upper gastrointestinal bleeding, esophageal varices, gastric cancer, etc. Gastric lavage should be performed with caution in comatose patients.

Precautions

1. Gastric lavage is mostly used for acute poisoning, and it is required to vomit out the food quickly, because delay will increase the absorption of poison and endanger life. Therefore, we must fight for time, every second counts, quickly prepare items, and perform gastric lavage immediately.

2. The general principle for gastric lavage is to do it as early as possible. Generally speaking, gastric lavage is most effective within 4 to 6 hours after taking poison. However, for some patients, it has been more than 6 hours since they sought medical treatment. In this case, gastric lavage may still be considered. The following factors may cause the poison to remain in the stomach for a long time: ① The patient has poor gastrointestinal function, causing the poison to remain in the stomach for a long time; ② Reabsorption of the poison after absorption; ③ More poison enters the stomach; ④ Some poisons are absorbed slowly, such as when the poison itself has a capsule shell.

3. Insertion of the catheter into the stomach should be done gently, quickly and skillfully, and lavage should begin after confirming that the catheter has entered the stomach (to extract gastric juice is the most reliable). Be careful not to accidentally insert the catheter into the respiratory tract during lavage. If severe coughing, shortness of breath, or cyanotic struggles occur during intubation, indicating that the tube has been mistakenly inserted into the airway, the tube should be removed quickly and reintubated. Patients who are in a coma or intubated and vomit are prone to aspiration pneumonia and should be cautiously prevented.

4. Warm boiled water is the most commonly used gastric lavage solution, which is effective and safe. 2% sodium bicarbonate solution is often used for poisoning by organophosphorus pesticides, but it should be noted that it should not be used for poisoning by trichlorfon, salicylate and strong acid. 1:5000 potassium permanganate solution has an oxidative detoxification effect on alkaloids and toxic mushroom alkaloids, but it is forbidden to use it for gastric lavage in patients with parathion poisoning. Therefore, the choice of gastric lavage fluid should be considered according to different poisons, and only clean water is the most widely used.

5. The amount of fluid injected each time during gastric lavage should not be too much. Generally, suction should be performed after 300 to 500 ml is injected each time. In particular, when using the positive pressure of an electric motor to deliver gastric lavage fluid, close observation should be made. When it reaches 500 ml, the positive pressure should be turned off and replaced with negative pressure suction. The operator should not open the site immediately after turning on the machine to prevent excessive infusion volume from causing acute gastric dilatation or even gastric perforation. Excessive infusion volume at one time can also easily cause a large amount of poison to enter the intestine, resulting in increased absorption of the poison. When using an electric gastric lavage machine, you should always add gastric lavage fluid to the bottle to avoid sending too much air into the stomach. When performing gastric lavage for ulcer disease combined with throttle obstruction, the lavage volume should be small and the pressure should be low to prevent perforation or bleeding.

6. Gastric lavage will cause certain damage if the poison is highly corrosive, and may cause perforation during intubation. It is generally not advisable to perform gastric lavage, and when a large amount of liquid enters, it is very easy to cause gastric perforation and tearing. Intubation of a seizure-prone patient may induce a seizure. Intubation of comatose patients can easily lead to aspiration pneumonia, so gastric lavage should be performed with caution. If gastric lavage is necessary, the patient should lie flat without a pillow, with the head tilted to one side to prevent suffocation caused by aspiration. Gastric lavage is not recommended for patients with esophageal varices.