II. Indications
- See Abdominal Trauma
III. Contraindications
- Do not perform Peritoneal Lavage when exploratory laparoscopy or laparotomy is clearly indicated
- Do not delay inevitable definitive evaluation for tests that will not modify management
- Multiple prior abdominal surgeries
- Advanced Cirrhosis
- Coagulopathy
- Morbid Obesity
- Pregnancy
IV. Precautions
- CT Abdomen and Pelvis (or bedside FAST Scan) is preferred over DPL in most cases
V. Interpretation: Positive Test
- Initial aspirate with gross blood >10 ml
- Unspun aspirate with >100k RBC or >500 WBC/mm3
- Aspirated lavage fluid with enteric contents (feces, bile, food)
- Lavage fluid exits the Foley Catheter or Chest Tube
VI. Complications
- Abdominal cavity infection
- Wound site infection
- Inaccurate results (False Positives and False Negatives)
- Organ perforation
- Failed procedure
VII. Technique: Infraumbilical Approach
- Preparation: Organ decompression
- Bladder decompression with Foley Catheter
- Stomach decompression with Nasogastric Tube or Orogastric Tube
- Preparation: Skin
- Apply skin antiseptic (e.g. hibiclens)
- Drape for sterile field
- Mark entry site
- Location 2-3 cm below the Umbilicus in midline
-
Anesthetic
- Inject Local Lidocaine 1% with Epinephrine at entry site
- Midline incision
- Cut a 2-4 mm midline incision at the anesthetized region
- Insert and advance needle
- Insert 18 gauge needle at 45 degree angle toward Pelvis
- Advance needle until into the peritoneum
- Aspirate for blood
- DPL is considered positive if >10 ml blood aspirated on entry (without lavage)
- Positive 10 ml blood aspiration on entry is an indication for surgery (no lavage needed)
- Seldinger Technique
- Advance J-Wire through needle and into Abdomen
- Remove the 18 gauge needle
- Advance peritoneal catheter (or 8-F Dialysis Catheter) along the J Wire
- Twist the catheter gently while inserting
- Peritoneal Lavage
- Attach tubing and sterile Normal Saline bag (IV bag) to the catheter
- Infuse 15 ml/kg (up to max of 1 Liter) of Normal Saline into peritoneum
- Empty Peritoneal Lavage
- Place saline bag below patient body level to allow fluid to drain back out of peritoneum and into bag
- Interpretation
- See results as above
VIII. References
- Warrington (2021) Crit Dec Emerg Med 35(8): 24
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Related Studies
| Definition (MSH) | Washing out of the peritoneal cavity. The procedure is a diagnostic as well as a therapeutic technique following abdominal trauma or inflammation. |
| Concepts | Diagnostic Procedure (T060) , Therapeutic or Preventive Procedure (T061) |
| MSH | D010533 |
| ICD9 | 54.25 |
| SnomedCT | 48034001, 178015005, 150558001, 387715005 |
| CPT | 49084 |
| English | Irrigation, Peritoneal, Irrigations, Peritoneal, Lavage, Peritoneal, Lavages, Peritoneal, Peritoneal Irrigation, Peritoneal Irrigations, Peritoneal Lavage, Peritoneal Lavages, Irrigation peritoneal cavity, diagnostic peritoneal lavage, peritoneal lavage, Irrigation of peritoneal cavity, Peritoneal cavity washout, Peritoneal lavage (procedure), Peritoneal lavage, Diagnostic peritoneal lavage |
| Japanese | 腹膜潅流, ﾌｸﾏｸｶﾝﾘｭｳ, 洗浄-腹腔, 腹腔洗浄, 腹膜洗浄, 洗浄-腹膜 |
| Swedish | Peritonealspolning |
| Czech | peritoneální výplach, Peritoneální laváž |
| Finnish | Vatsaontelonhuuhtelu |
| Russian | LAVAZH PERITONEAL'NYI, PERITONEAL'NYI LAVAZH, IRRIGATSIIA PERITONEAL'NAIA, PROMYVANIE BRIUSHINY, PERITONEAL'NAIA IRRIGATSIIA, ИРРИГАЦИЯ ПЕРИТОНЕАЛЬНАЯ, ЛАВАЖ ПЕРИТОНЕАЛЬНЫЙ, ПЕРИТОНЕАЛЬНАЯ ИРРИГАЦИЯ, ПЕРИТОНЕАЛЬНЫЙ ЛАВАЖ, ПРОМЫВАНИЕ БРЮШИНЫ |
| French | Irrigation péritonéale, Lavage du péritoine, Lavage péritonéal |
| Italian | Irrigazione peritoneale, Lavaggio peritoneale |
| Croatian | PERITONEJSKA LAVAŽA |
| Polish | Płukanie jamy otrzewnej, Irygacja otrzewnej |
| Hungarian | Peritonealis lavage |
| Spanish | irrigación de la cavidad peritoneal, lavado peritoneal (procedimiento), lavado peritoneal, Lavado peritoneal, Lavado Peritoneal, Irrigación Peritoneal |
| Norwegian | Peritoneal irrigasjon, Skylling av bukhulen, Peritoneal skylling, Peritoneal lavage |
| Portuguese | Lavagem peritoneal, Irrigação Peritoneal, Lavagem Peritoneal |
| Dutch | peritoneale spoeling, Irrigatie, peritoneale, Lavage, peritoneale, Peritoneale irrigatie, Peritoneale lavage |
| German | Lavage, peritoneale, Peritoneallavage, Bauchhöhlenspülung, Peritoneale Spülung, Spülung, peritoneale |
