How is diagnostic peritoneal lavage done?
Peritoneal lavage is a bedside procedure for evaluating bleeding in the abdominal cavity or a ruptured organ. In this procedure, a needle connected to a catheter, a tube-like structure, is inserted into your abdominal cavity. It is commonly known as diagnostic peritoneal lavage (DPL).
What is diagnostic peritoneal lavage and why?
Diagnostic peritoneal lavage (DPL) is an invasive emergency procedure used to detect hemoperitoneum and help determine the need for laparotomy following abdominal trauma. A catheter is inserted into the peritoneal cavity, followed by aspiration of intraperitoneal contents, often after their dilution with crystalloid.
What is DPL surgery?
One procedure used to determine whether blunt trauma victims require surgery is diagnostic peritoneal lavage (DPL). DPL helps determine whether an intra-abdominal injury exists and whether surgery is required. Using local anesthesia, the surgeon makes a small incision in the abdomen just below the umbilicus.
What is a positive lavage?
A positive DPL in an adult classically requires one of the following results: 10 ml gross blood on initial aspiration, > 500/mm3 white blood cells (WBC), > 100,000/mm3 red blood cells (RBC), or the presence of enteric/vegetable matter .
What happens during a peritoneal lavage?
The procedure entails inserting a catheter into the peritoneal cavity, initially to aspirate blood or fluid, and subsequently to infuse fluid and lavage the cavity, if necessary.
How long is peritoneal lavage?
A catheter is inserted towards the pelvis and aspiration of material attempted using a syringe. If no blood is aspirated, 1 litre of warm 0.9% saline is infused and after a few (usually 5) minutes this is drained and sent for analysis.
What is a peritoneal lavage used for?
How much fluid is needed for a positive fast?
The volume of free fluid necessary to enable detection with FAST represents a limitation of FAST . Branney and colleagues determined that the mean minimum detectable free-fluid volume during FAST examination in 100 patients undergoing DPL was 619 mL in the Morison pouch (24).
What is the purpose of peritoneal lavage?
What is considered a positive FAST exam?
A positive FAST result is defined as the appearance of a dark (“anechoic”) strip in the dependent areas of the peritoneum. In the right upper quadrant this typically appears in Morison’s Pouch (between the liver and kidney). This location is most useful as it is the place where fluid will collect with a supine patient.
What probe do you use for FAST exam?
The FAST exam most commonly uses the subxiphoid (AKA subcostal) view to assess the pericardial space. To obtain this view, place the transducer just inferior and to the patient’s right of the xiphoid process. Yes, you read that correctly – to the right of the xiphoid process.
When to use diagnostic peritoneal aspirate and lavage?
Diagnostic peritoneal aspirate and lavage is a rapid and easily performed but invasive bedside procedure that was once the gold standard for the evaluation of abdominal trauma [ 1 ]. The procedure was initially used in patients with blunt abdominal trauma, but its use quickly evolved to include some patients with penetrating trauma [ 2,3 ].
When was diagnostic peritoneal lavage ( DPL ) introduced?
Diagnostic peritoneal lavage (DPL) was introduced in 1965 as an expeditious and accurate method of identifying intra-abdominal hemorrhage. It is highly sensitive in that regard. However, it is invasive and fails to identify the exact source of bleeding.
How is peritoneal lavage sensitive for liver injury?
Diagnostic peritoneal lavage (DPL) is sensitive for hemoperitoneum (99%), but not specific for liver injury. Ultrasound (US) is highly sensitive in identifying >200 ml of intraperitoneal fluid. It is noninvasive and may be repeated at frequent intervals, but it is relatively poor for staging liver injuries.
What are the complications of DPL and laparoscopy?
The most worrisome complication for both DPL and laparoscopy is injury to the underlying viscera. Although the incidence of this complication is only 1%–2%, this complication is easily avoided by use of the open technique. Proponents of the closed technique cite a shorter procedure time as its greatest advantage.