Diagnostic Peritoneal Lavage (dpl)

King Saud University College of Nursing Di agnosti c Peri toneal La va ge (DP L) Hatem Alsrour

Pu rpose of DP L  Trauma   

Intraabdominal hemorrhage Visceral injury Perforation

 Other indications     

Pancreatitis Peritonitis Strangulating bowel Intestinal obstruction Malignant cells in peritoneal washing

What d o y ou need??  Arrow DPL kit (found in each trauma room)  Sterile gloves, gown, box of 4x4 gauze, pkg of sterile towels  Cleaning agent- Povidone iodine or chlorhexidine  Warmed 0.9% saline solution or Ringer’s lactate (physicians choice)  Patient labels, requisitions and specimen tubes  (1) no. 11 blade and (1) no. 15 blade  1% or 2% lidocaine with epinephrine

Pr epara tio n a nd Set-u p  Obtain appropriate consent.  Ensure that the patients stomach and bladder are decompressed.  If needed place orogastric (OG) or nasogatric (NG) tube to decompress the stomach and a foley to drain the bladder.  This will avoid puncturing the bladder or bowel.

 Place patient on a full monitor to record vital signs during procedure.  Assemble appropriate supplies.  Establish sterile field.  Assist MD by setting up lavage equipment.  This ensures that the warm fluid is available as soon as catheter is placed and that a closed system is quickly established.

 Assist with the administration of lidocaine.

 MD performs the initial tap to access the peritoneal space and to assess abdominal pathology.  Initial aspirate is drawn, labeled appropriately and sent to the lab.

 If the tap is dry (no fluid was obtained) a small incision may be made at the linea alba. This will facilitate catheter insertion.  After insertion of the catheter IV tubing and fluid are attached. Fluid can be instilled with a syringe or by gravity.  10-20ml/kg to a max of 1L.  The fluid is used to rinse the peritoneal cavity.

 Fluid is drained out of the peritoneal cavity by placing the IV fluid bag in a dependent position  After all fluid has been removed the MD will remove the catheter and suture the incision  Remove ~20cc fluid from the return, place in specimen tubes and send to lab for analysis

How d o I k now if my DPL is posi tive ??  Grossly bloody fluid  Red blood cell (RBC) count greater than 100,000/mm3. The threshold may be smaller for a patient with penetrating trauma to the abdomen or chest.  White blood cell (WBC) count greater than 500/mm3.

 10ml of blood or enteric contents (stool, food, etc.) constitutes a positive DPL, and operative exploration is warranted. Other positive findings include more than 100,000 RBCs/ml, 500 WBCs/ml, and amylase 175 IU. Lower thresholds may also be used, which will result in fewer false-negative tests, but increase the rate of negative laparotomy. Levels of 10,000 RBCs/ml are typically used in cases of penetrating trauma  Presence of bacteria, bile, stool or amylase in the abdominal fluid.

If yo ur DPL is posi tive . . . Prepare the patient for the Operating Room A positive DPL indicates intraabdominal injury that requires surgical intervention.