Gastric washing

The gastric washing is a Medical care, consisting in emptying the Estomac of its contents, and in particular making it possible to evacuate the poisons introduced, before their digestive resorption. The washing of the stomach is one of the principal methods of digestive purification used at the time of the acute intoxications, just like the caused vomiting, the adsorption of the poisons by the activated carbon or the acceleration of the intestinal transit time.

The method of gastric washing was largely used in the past, and remains the method most used in France at the time of the assumption of responsibility of the acute intoxications.

Its clinical effectiveness however was not established and its interest was very discussed and called in question. The activated carbon from now on is preferred with gastric washing, still too often practiced in a systematic way.

History

In France, a conference of consensus organized in 1992 on digestive purification specified the place of the various methods of digestive purification in the treatment of the acute intoxications by ingestion: Gastric washing is painful for the patient and length for the nurse. He does not dissuade the adult recidivist; he should not punish the disobeying child. It is not useful in the intoxication for benzodiazepines and hypnotic related. There is no consensus in the other situations. It is rational to propose it in hospital medium in the intoxications by the substances at toxic strong potential. In this case, gastric washing can be useful with an aim of withdrawing organization of the quantities - even negligible of poison, in partnership with the activated carbon when it is about a substance adsorbable. Nevertheless, the association of gastric washing and the activated carbon was not the proof of its superiority on the only use of the activated carbon.

In 1998, catches of position joint to two learned societies, the American Academy off Clinical Toxicology (AACT) and the European Association off Poison Centers and Clinical Toxicologists (EAPCCT) were published. They are more strict than those of the conference of consensus of 1992 of the Company of Reanimation of French language: Gastric washing should not be practiced systematically at the time of an acute intoxication. The quantity of marker purified by gastric washing under experimental conditions is very variable and decreases with time. There is no unquestionable proof of a possible beneficial clinical effect; gastric washing can involve a significant morbidity. Gastric washing should not be considered unless the patient did not introduce a potentially dangerous quantity of a poison and that it can be carried out in the 60 minutes following the intoxication. Even in this case, no beneficial clinical effect was found in the controlled studies. Gastric washing is contra-indicated when the reflexes of protection of the air routes are absent, unless the patient is not intubé. It is also contra-indicated at the time of the ingestion of caustic products or hydrocarbons with big risk of inhalation.

This standpoint leaves much less place to gastric washing than that of the consensus of 1992. It confirms the absence of proof of clinical effect beneficial, insists on the risk of morbidity associated, and implies that gastric washing has finally only little interest.

The French company of Anesthesia and Reanimation (SFAR), in its conference of actualization of 1998 tries to answer certain questions: Should gastric washing be given up? Surely yes in a very great number of serious intoxications not very, blaming of the only functional poisons and with moderate toxic potential (majority of the cases). But no definitive answer can be given in a peremptory way for the serious intoxication. Actually, the regulation is made on a case-by-case basis by being posed each time the question of the awaited benefit and the possible risks; in many cases, the possible risks are indeed more important than the awaited benefit.

Technique

Indications

The indications of gastric washing from now on are limited:

recent acute Ingestion (less than one front hour)

of an organic poison: Paraquat, Colchicine, Paracetamol
of a functional poison with strong toxicity: antiarythmic, antidepressants tricyclic, barbiturate, carbamates, chloroquine, digitalic, theophylline

Against indications

Gastric washing against is indicated:

when the reflexes of protection of the air routes are absent, unless the patient is not intubé.
at the time of the ingestion of caustic products or hydrocarbons with big risk of inhalation

Complications

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