Peritoneal Lavage

PERITONEAL LAVAGE By: Jose Byron Dadulla-Evardone RN

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Learning OBJECTIVE The Learner will be able to defined purpose of Peritoneal lavage  To know the steps and rationale of Peritoneal lavage  To identify the possible complication of peritoneal lavage 

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Terminologies Diagnostic peritoneal lavage – instillation of lactated ringer’s solution into the abdominal cavity to detect red blood cell, WBC, bile, bacteria, amylase, or gastrointestinal contents indicative of abdominal injury  Indwelling catheter - a catheter that remains in the bladder either for a short period to keep the bladder empty or for a long time period to control incontinence, prevent urinary retention or prevent leakage of urine. 

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Blunt trauma- to the abdomen is a major component of traumatic injury and can be deadly. Blunt trauma can occur during falls, motor vehicle accidents, or severe blows to the abdomen.

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PURPOSE OF THE SKILL 

Peritoneal Lavage – Washing out of the peritoneal cavity. The procedure is a diagnostic as well as a therapeutic technique following abdominal trauma or inflammation Is used as diagnostic procedure in a patient with:

1.BLUNT ABDOMINAL TRAUMA 2.Detect bleeding in the Peritoneal cavity college of nursing

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A. Assessment : 

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Evaluate client status: level of consciousness: level of alertness, previous experience with dialysis or peritoneal lavage and understanding of and familiarity with the procedure. Assess the need for Peritoneal lavage and type of catherization ordered Rationale : to ensure proper procedure is carried out

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Assess abdomen for any signs of infection or inflammation. Ask client for any history of difficulty with prior Peritoneal lavage if any Rationale : allow detection of potential complication

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Watch out for indication of distress college of nursing

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B. Diagnosis  Risk

for infection, related to invasive device  Risk for impaired Skin integrity, related to infection and pressure from catheter  Risk for hypovolemia, related to excess fluid drain  Deficient knowledge , related to insertion of catheter college of nursing

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C. IMPLEMENTATION- SKILLS/ STEP WHAT YOU NEED??? 1. 2. 3. 4. 5.

Indwelling urinary catheter Catheter insertion kit and drainage bag Nasogastric tube Gastric suction machine Shaving kit

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WHAT YOU NEED??? 1. 2. 3.

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I.V pole Macrodrip I.V tubing I.V Solution ( 1L warmed, balance saline solution usually LRS or NSS) – Rationale : to prevent patient discomfort and abdominal pain and to dilate the vessels of the peritoneum to increase urea clearance Peritoneal dialysis tray Peritoneal Lavage Tray: 1 Povidone-Iodine swabstick;1 Absorbent towel;1 Fenestrated drape;1 Lazarus Nelson catheter 9fr radiopaque w/guidewire;1 Syringe 5cc (Luer Lock);1 Needle 20G x 1 1/2";1 Needle 21G z 1 1/2";1 Needle 25G x 5/8";1 Needle 18G x 3";1 Syringe 10cc (Luer Slip);1 Scalpel blade w/handle;3 Gauze pads;1 Bandage

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Sterile gloves college of nursing

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WHAT YOU NEED??? 11. Gown 2. Goggles 3. Antiseptic solution (Povidone iodine) 4. 1= 3 ml syringe (25 gauge 1” needle) 1= 30 ml syringe 1= 20G 1 ½ needle. 5. Bottle of 1% lidocaine with epinephrine 6. # 14 intracatheter extension tubing [ length = 8 inch or 20.3 cm] 7. A small sterile hemostat [to clamp tubing] college of nursing

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WHAT YOU NEED??? 1. 2.

3. 4. 5. 6. 7. 8.

Sterile towels 3 sterile bottle container for specimen collection and 1= sterile tube for a culture and sensitivity specimen Labels Antiseptic ointment 4x4 gauze pads Alcohol pads 1’’ hypoallergenic tape 2-0 and 3-0 sutures college of nursing

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Special consideration 

If using a commercially prepared PERITONEAL DIALYSIS KIT which contains : • #15 peritoneal dialysis catheter • Trocar • And extension tubing with roller clamp

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Make Sure The Macrodrip IV Tubing Doesn’t Have A REVERSE FLOW(OR BACK-CHECK VALVE)- it prevents infused fluid from draining out of the peritoneal cavity. college of nursing

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 Tell

Client what to expect :

Before the procedure, advise the patient to expect a • sensation of abdominal fullness. • Chills if lavage isn’t warmed or doesn’t reach his body temperature

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How do you do it ?? I. Provide privacy

II. Wash your hands

III. Reinforce the doctor’s explanation of the procedure

IV. Put on the gown and goggles

V. Catheterize the patient with the indwelling urinary catheter and connect to the drainage bag • RATIONALE : to prevent laceration or puncture of bladder

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How do you do it ?? VI. 

Insert the NG tube . Attached this tube to the gastric suction machine ( set for low intermittent suction) RATIONALE: 1. 2. 3.

to drain the patient’s stomach contents. Decompressing the stomach prevent vomiting and aspiration Minimize the possibility of bowel perforation during trocar or catheter insertion.

VII. 

Using the shaving kit, clip or shave the hair, as ordered, from the area between the patient’s umbilicus and pubis.

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How do you do it ?? VIII.  Set-up IV pole. Attached the macrodrip tubing to the LAVAGE solution container, and clear air from the tubing RATIONALE : to avoid introducing air into the peritoneal cavity during the lavage.

IX.  Using aseptic technique, open the peritoneal dialysis tray. college of nursing

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How do you do it ?? X. DOCTOR TASK: The doctor will wipe the patient’s abdomen with the antiseptic solution drape the area with sterile towels • RATIONALE : to create a sterile field

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How do you do it ?? X. NURSE TASK: Using Aseptic Technique– hand the doctor the 3 ml syringe and 25G 1’’ needle Important consideration: If the peritoneal dialysis tray doesn’t contain a sterile ampule of anesthetic----- wipe the top of multidose vial of 1 % lidocaine with epinephrine with an alcohol pad invert the vial at 45 degree angle • RATIONALE : Allows the doctor to insert the needle and withdraw the anesthetic without touching the nonsterile vial. college of nursing

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How do you do it ?? X. DOCTOR TASK: Diagnosis: Inject anesthetic below the umbilicus & he’ll make incision

Insert trocar or catheter

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How do you do it ?? X. DOCTOR TASK: Diagnosis: Inject anesthetic below the umbilicus

Insert trocar or catheter

Withdraw fluid & check findings

Findings are positive

Findings: fluid clear or looks normal

Procedure ends college of nursing Prepare for LAPAROTOMY

LAVAGE WILL CONTINUE 22

How do you do it ?? Findings: fluid clear or looks normal LAVAGE WILL CONTINUE

XI. Implementation  Wearing gloves ---- Connect the catheter extension tubing to the IV tubing , if ordered and still 500 to 1000 ml of warmed IV solution into the peritoneal cavity over 5-10 minutes---- then clamp the tubing with Hemostat. Unless C.I = gently tilt the patient from side to side • RATIONALE : distribute the fluid throughout the peritoneal cavity.

If tilting is C.I = may gently palpate the sides of the abdomen • RATIONALE: to distribute fluid college of nursing

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How do you do it?? XII . after 5-10 minutes ----Place I.V container below the level of patient’s body and open the clamp on the IV tubing • RATIONALE : Lowering the container helps excess fluid to drain.

Gently drain as much as fluid as possible from the peritoneal cavity to the container. BE CAREFUL – not to disconnect the tubing from the catheter • DRAINING TIME : 20-30 minutes to complete college of nursing

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SPECIMEN XIII .  To Obtain fluid specimen: Put on the gloves Use 30 ml syringe gauge 20 1 ½ “ needle ( to withdraw between 25 and 30 ml of fluid from a port in the IV tubing. Clean the top of each specimen container with an alcohol pad. Deposit fluid specimens in the labeled containers and send the specimen to the laboratory • NOTE : for C/S : change needle – Rationale : to avoid contaminating the specimen. college of nursing

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AFTER CARE XIV .  The doctor will close the incision  Nurse task : wearing sterile gloves --- apply antiseptic ointment to the site and dress the incision with 4x4 gauze pad Discard the disposable equipment Return reusable equipment to the appropriate department for cleaning & sterilization.

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AFTER CARE XV.  AFTER LAVAGE : monitor the patient vital signs Report signs and symptoms of shock [ tachycardia, decrease BP, diaphoresis, dyspnea and vertigo] Assess the incisional site frequently for bleeding. college of nursing

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D. EVALUATION  Vital

sign was stable  The catheter was inserted without pain, trauma, or injury to the client  The client’s bladder was emptied without complication  The nurse maintained the sterility of the catheter during and after insertion . college of nursing

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Documentation 

After Peritoneal Lavage Record Type and size of peritoneal dialysis catheter used. Type and amount of solution instilled into and withdrawn from the peritoneal cavity Amount and color of fluid returned. Whether the fluid flowed freely into and out of the abdomen Specimen obtained and sent to the laboratory Complication and nursing intervention. college of nursing

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The End

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