Stomach pumping

Overview

Stomach pumping, or gastric suctioning/lavage, is a medical procedure that involves inserting a tube through the nose or mouth into the stomach. The procedure rinses the stomach with water or saline and suctions out its contents.

While commonly associated with emergencies—such as cases of poisoning or overdoses, where it aids in removing toxins before absorption—stomach pumping has other significant applications. It can alleviate stomach pressure caused by food, fluids, or air, and help remove excess blood in cases of bleeding.

In addition, gastric suctioning is utilized during procedures like abdominal surgery to eliminate excess fluids, reducing the risk of regurgitation and choking. It often includes a saline wash to cleanse the stomach and minimize infection risk.

Reasons for undergoing the procedure

Stomach pumping may be recommended for certain conditions, such as:

• Upper GI bleeding
• Poisoning, or toxin ingestion
• Gastroparesis or gastric outlet obstruction
• Small bowel obstruction or pseudo-obstruction
• Persistent nausea and vomiting.

Gastric suctioning may be needed in procedures, such as:

• Upper endoscopy
• Stomach acid test
• Gastrointestinal operations.
• Assisted ventilation

Stomach pumping has become less common in recent years. The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists now discourage its routine use for gastrointestinal decontamination. They agree that other methods, like activated charcoal or whole bowel irrigation, can often be safer and more effective alternatives.

Risks

Although risks are possible, stomach pumping has generally few complications, such as:

• Irregular heartbeats if the tube stimulates the vagus nerve
• Inhaling or aspiration of stomach contents if vomiting happens
• Injury to the stomach or esophagus from the tube
• Misplacing the tube into the airway instead of the stomach

Before the procedure

Prior stomach pumping, the healthcare provider will test one’s gag reflex and may insert a breathing tube if needed to keep the airways open during the procedure. An individual’s vital signs are monitored before, during, and after.

Before stomach pumping can be safely performed, other treatments may be necessary. If the patient is conscious, healthcare providers will explain the procedure and obtain informed consent.

During the procedure

Stomach pumping uses two types of tubes:

• Nasogastric tube: It is inserted through the nose.
• Orogastric tube: It is inserted though the mouth. This is often preferred for stomach emptying due to its larger size.

Stomach pumping involves using any of these tube to connect the stomach to a pump. 

These may be expected during tube insertion:

• The healthcare provider positions the patient semi-upright or on their left side with their head angled down.
• A topical anesthetic spray is applied to the throat to prevent gagging.
• A bite block is placed in the patient’s mouth if an orogastric tube is being used, to prevent biting down on the tube.
• The length of the tube needed to reach the stomach is measured and marked.
• The tip of the tube is lubricated and is guided toward the back of the throat and into the esophagus.

If one coughs, gags, or shows distress, the healthcare provider will pause, withdraw the tube, and try again after a short break.

Once in place, the healthcare provider confirms the tube’s position using methods like X-rays or testing stomach juices for acidity.

Gastric lavage may start once the tube is correctly positioned. It usually proceed as follows:

• Choose an appropriate fluid for lavage, which may include:
  • Tap water
  • Saline solution, to prevent electrolyte loss, especially in children or those already dehydrated
  • Specific antidotes
• Using a funnel, syringe, or mechanical irrigant, a small amount of fluid is administered into the stomach (10 mL for children or as much as 300 mL for adults).
• The fluid is withdrawn after one to two minutes, using gravity drainage, syringe, suction bulb, or mechanical suction.
• The process is repeated until the returned fluid is clear or two to three liters have been used. This helps remove stomach contents and keep the tube clear.
• If necessary, activated charcoal may be added to the final fluid to bind leftover poisons and might be left in the stomach to capture any remaining toxins in the intestines.

Gastric pumping itself is not painful, but the tube can be uncomfortable, particularly during insertion and removal. To minimize discomfort, healthcare providers lubricate the tube, use topical anesthetics, and employ gentle techniques.  

Despite certain measures, some individuals may still experience irritation or a gagging sensation. Securing the tube in place helps reduce friction, but some friction can still occur with movement.

After the procedure

After the procedure, patients will be monitored for several hours to check for any signs of complications from the procedure or, in cases of toxic ingestion, from the toxins themselves.

If the patient is not undergoing surgery, the provider will carefully remove the tube, ensuring that there is no contact with the contents inside. In surgical cases, the tube may remain in place for a few days. 

Outcome

Seek emergency care immediately if someone has overdosed on drugs, ingested poison, or has alcohol poisoning. Even without obvious symptoms, seek professional advice if poisoning is suspected, and do not attempt to treat it at home without guidance.

Symptoms of poisoning include:

• Loss of consciousness 
• Confusion
• Drowsiness
• Agitation
• Seizures
• Chemical smell on the breath
• Burns around the mouth
• Dizziness
• Nausea
• Vomiting
• Heart palpitations
• Breathing difficulties

Stomach pumping may be recommended based on what was ingested, the quantity, and the time since ingestion, as it can sometimes be ineffective or pose risks. Immediate medical attention is crucial in any poisoning scenario.

While stomach pumping can be lifesaving in cases of toxic ingestion, it also has other important functions. It can help alleviate symptoms, support further treatment or testing, and serve as a precaution to prevent vomiting, especially during medical procedures where vomiting could be hazardous.