Emergency Medicine Book

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Diagnostic Peritoneal Lavage

Aka: Diagnostic Peritoneal Lavage, Peritoneal Lavage
  1. Indications
    1. See Abdominal Trauma
  2. 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
  3. Precautions
    1. CT Abdomen and Pelvis (or bedside FAST Scan) is preferred over DPL in most cases
  4. 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
  5. Complications
    1. Abdominal cavity infection
    2. Wound site infection
    3. Inaccurate results (False Positives and False Negatives)
    4. Organ perforation
    5. Failed procedure
  6. 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
  7. References
    1. Warrington (2021) Crit Dec Emerg Med 35(8): 24

Peritoneal lavage (C0031148)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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