Peritoneal Lavage

college of nursing 1

PERITONEAL LAVAGE

By:

Jose Byron Dadulla-Evardone RN


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


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.


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.


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 TRAUMA2.Detect bleeding in the Peritoneal

cavity


A. Assessment :

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 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 Watch out for indication of distress


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


WHAT YOU NEED???

1. Indwelling urinary catheter

2. Catheter insertion kit and drainage bag

3. Nasogastric tube

4. Gastric suction machine

5. Shaving kit

C. IMPLEMENTATION- SKILLS/ STEP


WHAT YOU NEED???

6. I.V pole7. Macrodrip I.V tubing8. 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

9. 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

10. Sterile gloves


WHAT YOU NEED???

11. Gown12. Goggles13. Antiseptic solution (Povidone iodine)14. 1= 3 ml syringe (25 gauge 1” needle)

1= 30 ml syringe 1= 20G 1 ½ needle.

15. Bottle of 1% lidocaine with epinephrine16. # 14 intracatheter extension tubing

[ length = 8 inch or 20.3 cm]17. A small sterile hemostat [to clamp tubing]


WHAT YOU NEED???

18. Sterile towels19. 3 sterile bottle container for specimen

collection and 1= sterile tube for a culture and sensitivity specimen

20. Labels21. Antiseptic ointment22. 4x4 gauze pads23. Alcohol pads24. 1’’ hypoallergenic tape25. 2-0 and 3-0 sutures


Special consideration

If using a commercially prepared PERITONEAL DIALYSIS KIT which contains :

• #15 peritoneal dialysis catheter• Trocar• And extension tubing with roller clamp

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.


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


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


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. to drain the patient’s stomach contents.2. Decompressing the stomach prevent vomiting and

aspiration3. 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.


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.


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


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.


How do you do it ??X. DOCTOR TASK:

Diagnosis:

Inject anesthetic below the umbilicus & he’ll make incisionInject anesthetic below the umbilicus & he’ll make incision

Insert trocar or catheter Insert trocar or catheter


How do you do it ??X. DOCTOR TASK:

Diagnosis:

Inject anesthetic below the umbilicus Inject anesthetic below the umbilicus

Insert trocar or catheter Insert trocar or catheter

Withdraw fluid & check findingsWithdraw fluid & check findings

Findings are positiveFindings are positive Findings: fluid clear or looks normalFindings: fluid clear or looks normal

Procedure endsPrepare for LAPAROTOMYProcedure endsPrepare for LAPAROTOMY

LAVAGE WILL CONTINUELAVAGE WILL CONTINUE


How do you do it ??

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

Findings: fluid clear or looks normalFindings: fluid clear or looks normal LAVAGE WILL CONTINUELAVAGE WILL CONTINUE


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


SPECIMEN

XIII . To Obtain fluid specimen:

Put on the glovesUse 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.


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.


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.


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 .


Documentation

After Peritoneal Lavage RecordType 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.


The End

Peritoneal Lavage

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