Diagnostic Peritoneal Lavage

Aka: Diagnostic Peritoneal Lavage, Peritoneal Lavage

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II. Indications

  1. See Abdominal Trauma

III. Contraindications

  1. Do not perform Peritoneal Lavage when exploratory laparoscopy or laparotomy is clearly indicated
    1. Do not delay inevitable definitive evaluation for tests that will not modify management
  2. Multiple prior abdominal surgeries
  3. Advanced Cirrhosis
  4. Coagulopathy
  5. Morbid Obesity
  6. Pregnancy

IV. Precautions

  1. CT Abdomen and Pelvis (or bedside FAST Scan) is preferred over DPL in most cases

V. Interpretation: Positive Test

  1. Initial aspirate with gross blood >10 ml
  2. Unspun aspirate with >100k RBC or >500 WBC/mm3
  3. Aspirated lavage fluid with enteric contents (feces, bile, food)
  4. Lavage fluid exits the Foley Catheter or Chest Tube

VI. Complications

  1. Abdominal cavity infection
  2. Wound site infection
  3. Inaccurate results (False Positives and False Negatives)
  4. Organ perforation
  5. Failed procedure

VII. Technique: Infraumbilical Approach

  1. Preparation: Organ decompression
    1. Bladder decompression with Foley Catheter
    2. Stomach decompression with Nasogastric Tube or Orogastric Tube
  2. Preparation: Skin
    1. Apply skin antiseptic (e.g. Hibiclens)
    2. Drape for sterile field
  3. Mark entry site
    1. Location 2-3 cm below the Umbilicus in midline
  4. Anesthetic
    1. Inject Local Lidocaine 1% with Epinephrine at entry site
  5. Midline incision
    1. Cut a 2-4 mm midline incision at the anesthetized region
  6. Insert and advance needle
    1. Insert 18 gauge needle at 45 degree angle toward Pelvis
    2. Advance needle until into the peritoneum
  7. Aspirate for blood
    1. DPL is considered positive if >10 ml blood aspirated on entry (without lavage)
    2. Positive 10 ml blood aspiration on entry is an indication for surgery (no lavage needed)
  8. Seldinger Technique
    1. Advance J-Wire through needle and into Abdomen
    2. Remove the 18 gauge needle
    3. Advance peritoneal catheter (or 8-F Dialysis Catheter) along the J Wire
      1. Twist the catheter gently while inserting
  9. Peritoneal Lavage
    1. Attach tubing and sterile Normal Saline bag (IV bag) to the catheter
    2. Infuse 15 ml/kg (up to max of 1 Liter) of Normal Saline into peritoneum
  10. Empty Peritoneal Lavage
    1. Place saline bag below patient body level to allow fluid to drain back out of peritoneum and into bag
  11. Interpretation
    1. See results as above

VIII. References

  1. Warrington (2021) Crit Dec Emerg Med 35(8): 24

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