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Diagnostic peritoneal lavage: a review of indications, technique, and interpretation.

Whitehouse JS, Weigelt JA - Scand J Trauma Resusc Emerg Med (2009)

Bottom Line: Diagnostic peritoneal lavage (DPL) is a highly accurate test for evaluating intraperitoneal hemorrhage or a ruptured hollow viscus, but is performed less frequently today due to the increased use of focused abdominal sonography for trauma (FAST) and helical computed tomography (CT).All three of these exams have advantages and disadvantages and thus each still play unique roles in the evaluation of abdominal trauma.Since DPL is performed less frequently today, a review of its indications, technique, and interpretation is pertinent.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical College of Wisconsin, Department of Surgery, Milwaukee, WI 53226, USA. jwhiteho@mcw.edu

ABSTRACT
Diagnostic peritoneal lavage (DPL) is a highly accurate test for evaluating intraperitoneal hemorrhage or a ruptured hollow viscus, but is performed less frequently today due to the increased use of focused abdominal sonography for trauma (FAST) and helical computed tomography (CT). All three of these exams have advantages and disadvantages and thus each still play unique roles in the evaluation of abdominal trauma. Since DPL is performed less frequently today, a review of its indications, technique, and interpretation is pertinent.

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After fluid is instilled, the bag is placed onto the floor to allow the intraabdominal fluid to return. 30% of the original amount of instilled fluid is required for an adequate sample.
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Figure 4: After fluid is instilled, the bag is placed onto the floor to allow the intraabdominal fluid to return. 30% of the original amount of instilled fluid is required for an adequate sample.

Mentions: A syringe is used to aspirate the peritoneal contents. If blood flows easily into the syringe, most accept this as a positive aspirate and proceed with laparotomy. Others suggest 10 ml of blood constitutes a positive result [10]. In the absence of 10 ml blood, the DPL catheter is connected to a warmed liter bag of Lactated Ringers or normal saline using standard intravenous tubing. Care must be taken that the tubing has no one-way valves which would not allow fluid to flow freely back into the IV fluid bag. While the fluid infuses, gently rock the patient to allow mixing of the fluid with peritoneal contents. Once the bag is almost empty, place it on the floor and allow the intraabdominal fluid to return (Figure 4). Adequate fluid analysis requires at least 30% of the original amount infused. This usually amounts to 300–350 ml in an adult. In the pediatric patient, 10–15 ml/kg of fluid is infused and an adequate return is 20–30% of the total infusion [16]. This fluid is sent for gram stain and analysis of the red blood cell count and white blood cell count. It also should be grossly examined for enteric, bilious, or vegetable matter content. The wound is irrigated and only the skin requires surgical closure with either sutures or staples. If the open technique is used, the incised fascia should be closed. This stitch can be placed while the fluid is infusing and secured once the catheter is removed. If a closed technique is used then no stitch is required.


Diagnostic peritoneal lavage: a review of indications, technique, and interpretation.

Whitehouse JS, Weigelt JA - Scand J Trauma Resusc Emerg Med (2009)

After fluid is instilled, the bag is placed onto the floor to allow the intraabdominal fluid to return. 30% of the original amount of instilled fluid is required for an adequate sample.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2663535&req=5

Figure 4: After fluid is instilled, the bag is placed onto the floor to allow the intraabdominal fluid to return. 30% of the original amount of instilled fluid is required for an adequate sample.
Mentions: A syringe is used to aspirate the peritoneal contents. If blood flows easily into the syringe, most accept this as a positive aspirate and proceed with laparotomy. Others suggest 10 ml of blood constitutes a positive result [10]. In the absence of 10 ml blood, the DPL catheter is connected to a warmed liter bag of Lactated Ringers or normal saline using standard intravenous tubing. Care must be taken that the tubing has no one-way valves which would not allow fluid to flow freely back into the IV fluid bag. While the fluid infuses, gently rock the patient to allow mixing of the fluid with peritoneal contents. Once the bag is almost empty, place it on the floor and allow the intraabdominal fluid to return (Figure 4). Adequate fluid analysis requires at least 30% of the original amount infused. This usually amounts to 300–350 ml in an adult. In the pediatric patient, 10–15 ml/kg of fluid is infused and an adequate return is 20–30% of the total infusion [16]. This fluid is sent for gram stain and analysis of the red blood cell count and white blood cell count. It also should be grossly examined for enteric, bilious, or vegetable matter content. The wound is irrigated and only the skin requires surgical closure with either sutures or staples. If the open technique is used, the incised fascia should be closed. This stitch can be placed while the fluid is infusing and secured once the catheter is removed. If a closed technique is used then no stitch is required.

Bottom Line: Diagnostic peritoneal lavage (DPL) is a highly accurate test for evaluating intraperitoneal hemorrhage or a ruptured hollow viscus, but is performed less frequently today due to the increased use of focused abdominal sonography for trauma (FAST) and helical computed tomography (CT).All three of these exams have advantages and disadvantages and thus each still play unique roles in the evaluation of abdominal trauma.Since DPL is performed less frequently today, a review of its indications, technique, and interpretation is pertinent.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical College of Wisconsin, Department of Surgery, Milwaukee, WI 53226, USA. jwhiteho@mcw.edu

ABSTRACT
Diagnostic peritoneal lavage (DPL) is a highly accurate test for evaluating intraperitoneal hemorrhage or a ruptured hollow viscus, but is performed less frequently today due to the increased use of focused abdominal sonography for trauma (FAST) and helical computed tomography (CT). All three of these exams have advantages and disadvantages and thus each still play unique roles in the evaluation of abdominal trauma. Since DPL is performed less frequently today, a review of its indications, technique, and interpretation is pertinent.

Show MeSH
Related in: MedlinePlus