DPL (DIAGNOSTIC PERITONEAL LAVAGE)

1. This procedure is used  to detect hemoperitoneum. Most commonly performed on pt with blunt abdominal trauma and  occasionally on penetrating trauma in which the depth of penetration is questionable.
    
2. DPL  should not be performed in cases with previous surgeries, pregnancy beyond 1st trimester, or  pt that requires obvious laparotomy.
    
3. Supra-umbilical approach used if: a) patient is pregnant  b)previous abdominal surgery c) pelvic fracture.
    
4. Here we'll discuss "open" and "closed" techniques. In both techniques it is recommended to empty  the bladder prior to attempt.

OPEN METHOD: (you need iodine, scalpel, gauze, Lidocaine, retractor,
                             hemostat, PD catheter, 20 ml syringe)

1. Prep and anesthetize skin 2-3 cm below or above umbilicus.
    
2. Make vertical 3 cm incision with a scalpel at above area (3 cm below or above umbilicus).
    
3. Apply retractors, make your way through fascia at the linea alba, and place lateral stay sutures using absorbable material on either side of the fascia.  Now  grasp the peritoneum with hemostats and make a 2 cm incision.
    
4. Insert the PD catheter into the peritoneal cavity and aim towards pelvis. Aspirate to see if there is any return. If >20 ml blood is withdrawn, DPL is (+)ve. If < 20 ml, pour 1 L NS via PD catheter and allow fluid to drain by gravity.   85-90% of fluid should be recovered prior to analysis. See "Trauma" chapter for interpretation of results.
    
5. Remove PD catheter and close layers.

CLOSED METHOD: (you need one18 gauge needle, iodine, Lidocaine, 20 ml
                                  syringe, scalpel)

1. Insert the needle 1-2 cm below or above umbilicus. You should feel two resistances - the linea alba and then the peritoneum.
    
2. Catheter is left in place while needle is removed.
    
3. Aspirate as above and follow same algorithm. See "Trauma" chapter for interpretation of results.

Note!!! Both methods may have no fluid return. If only 100 ml is obtained, send that to the  labs, since the rest will be absorbed. If nothing comes out a combination of  "rocking" the abdomen, turning or withdrawing the catheter,  infusing 500-1000 ml more of  NS, and placing pt in Trendelenburg  may be helpful.

[BACK]