King Saud UniversityKing Saud UniversityCollege of NursingCollege of Nursing

Diagnostic Peritoneal Diagnostic Peritoneal Lavage (DPL) Lavage (DPL)

Hatem AlsrourHatem Alsrour

Purpose of DPLPurpose of DPL Trauma Trauma

Intraabdominal hemorrhage Intraabdominal hemorrhage Visceral injuryVisceral injury PerforationPerforation

Other indicationsOther indications PancreatitisPancreatitis PeritonitisPeritonitis Strangulating bowelStrangulating bowel Intestinal obstructionIntestinal obstruction Malignant cells in peritoneal washingMalignant cells in peritoneal washing

What do you need??What do you need??

Arrow DPL kit (found in each trauma room)Arrow DPL kit (found in each trauma room) Sterile gloves, gown, box of 4x4 gauze, pkg of sterile Sterile gloves, gown, box of 4x4 gauze, pkg of sterile

towelstowels Cleaning agent- Povidone iodine or chlorhexidineCleaning agent- Povidone iodine or chlorhexidine WarmedWarmed 0.9% saline solution or Ringer’s lactate 0.9% saline solution or Ringer’s lactate

(physicians choice) (physicians choice) Patient labels, requisitions and specimen tubesPatient labels, requisitions and specimen tubes (1) no. 11 blade and (1) no. 15 blade(1) no. 11 blade and (1) no. 15 blade 1% or 2% lidocaine with epinephrine1% or 2% lidocaine with epinephrine

Preparation and Set-up Preparation and Set-up Obtain appropriate consent.Obtain appropriate consent. Ensure that the patients stomach and bladder are Ensure that the patients stomach and bladder are

decompressed.decompressed. If needed place orogastric (OG) or nasogatric (NG) tube to If needed place orogastric (OG) or nasogatric (NG) tube to

decompress the stomach and a foley to drain the bladder.decompress the stomach and a foley to drain the bladder. This will avoid puncturing the bladder or bowel.This will avoid puncturing the bladder or bowel.

Place patient on a full monitor to record vital signs Place patient on a full monitor to record vital signs during procedure.during procedure.

Assemble appropriate supplies.Assemble appropriate supplies. Establish sterile field.Establish sterile field. Assist MD by setting up lavage equipment.Assist MD by setting up lavage equipment.

This ensures that the warm fluid is available as soon as This ensures that the warm fluid is available as soon as catheter is placed and that a closed system is quickly catheter is placed and that a closed system is quickly established.established.

Assist with the administration of lidocaine.Assist with the administration of lidocaine.

MD performs the MD performs the initial tap to access initial tap to access the peritoneal space the peritoneal space and to assess and to assess abdominal pathology.abdominal pathology.

Initial aspirate is Initial aspirate is drawn, labeled drawn, labeled appropriately and appropriately and sent to the lab.sent to the lab.

If the tap is dry (no fluid If the tap is dry (no fluid was obtained) a small was obtained) a small incision may be made at incision may be made at the linea alba. This will the linea alba. This will facilitate catheter insertion.facilitate catheter insertion.

After insertion of the After insertion of the catheter IV tubing and fluid catheter IV tubing and fluid are attached. Fluid can be are attached. Fluid can be instilled with a syringe or instilled with a syringe or by gravity. by gravity.

10-20ml/kg to a max of 1L.10-20ml/kg to a max of 1L. The fluid is used to rinse The fluid is used to rinse

the peritoneal cavity.the peritoneal cavity.

Fluid is drained out of the Fluid is drained out of the peritoneal cavity by placing peritoneal cavity by placing the IV fluid bag in a the IV fluid bag in a dependent positiondependent position

After all fluid has been After all fluid has been removed the MD will removed the MD will remove the catheter and remove the catheter and suture the incision suture the incision

Remove ~20cc fluid from Remove ~20cc fluid from the return, place in the return, place in specimen tubes and send specimen tubes and send to lab for analysisto lab for analysis

How do I know if my DPL How do I know if my DPL is positive??is positive??

Grossly bloody fluidGrossly bloody fluid Red blood cell (RBC) count greater than Red blood cell (RBC) count greater than

100,000/mm100,000/mm3. 3. The threshold may be smaller for The threshold may be smaller for a patient with penetrating trauma to the a patient with penetrating trauma to the abdomen or chest.abdomen or chest.

White blood cell (WBC) count greater than White blood cell (WBC) count greater than 500/mm500/mm3.3.

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

Presence of bacteria, bile, stool or amylase Presence of bacteria, bile, stool or amylase in the abdominal fluid.in the abdominal fluid.

If your DPL is positive. . .If your DPL is positive. . .

Prepare the patient Prepare the patient

for the Operating Roomfor the Operating Room

A positive DPL indicates intraabdominal A positive DPL indicates intraabdominal injury that requires surgical intervention.injury that requires surgical intervention.