Diagnostic Peritoneal Lavage (DPL)

Diagnostic Peritoneal Lavage (DPL)

)Diagnostic Peritoneal Lavage (DPL)
A. Purpose of DPL
1. Trauma
a. Intraabdominal hemorrhage
b. Visceral injury
c. Perforation
2. Other indications
a. Pancreatitis
b. Peritonitis
c. Strangulating bowel
d. Intestinal obstruction
e. Malignant cells in peritoneal washing
B. Case :
“The doctor says I want to do a DPL on this patient. . . What do you need??”
1. Arrow DPL kit (found in each trauma room)
2. Sterile gloves, gown, box of 4x4 gauze, pkg of sterile towels
3. Cleaning agent- Povidone iodine or chlorhexidine
4. Warmed 0.9% saline solution or Ringer’s lactate (physicians choice)
5. Patient labels, requisitions and specimen tubes
a. no. 11 blade and (1) no. 15 blade
6. 1% or 2% lidocaine with epinephrine
C. Preparation and Set-up
1. Obtain appropriate consent
2. Ensure that the child’s stomach and bladder are decompressed
3. If needed place orogastric (OG) or nasogatric (NG) tube to decompress the stomach and a foley to drain the bladder
4. This will avoid puncturing the bladder or bowel.
5. Place child on a full monitor to record vital signs during procedure.
6. Assemble appropriate supplies
7. Establish sterile field
8. Perform “Time-Out”
9. Assist MD by setting up lavage equipment
10. This ensures that the warm fluid is available as soon as catheter is placed and that a closed system is quickly established.
11. Assist with the administration of lidocaine
12. MD performs the initial tap to access the peritoneal space and to assess abdominal pathology.
13. Initial aspirate is drawn, labeled appropriately and sent to the lab.
14. If the tap is dry (no fluid was obtained) a small incision may be made at the linea alba. This will facilitate catheter insertion.
15. After insertion of the catheter IV tubing and fluid are attached. Fluid can be instilled with a syringe or by gravity.
16. 10-20ml/kg to a max of 1L.
17. The fluid is used to rinse the peritoneal cavity.
18. Fluid is drained out of the peritoneal cavity by placing the IV fluid bag in a dependent position
19. After all fluid has been removed the MD will remove the catheter and suture the incision
20. Remove ~20cc fluid from the return, place in specimen tubes and send to lab for analysis
D. How do I know if my DPL is positive??
1. Grossly bloody fluid
2. Red blood cell (RBC) count greater than 100,000/mm3. The threshold may be smaller for a child with penetrating trauma to the abdomen or chest.
3. White blood cell (WBC) count greater than 500/mm3.
4. Presence of bacteria, bile, stool or amylase in the abdominal fluid.
E. If your DPL is positive. . .
1. Prepare the child
2. for the Operating Room
3. A positive DPL indicates intraabdominal injury that requires surgical intervention.