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V)
PERITONEAL LAVAGE
1) INDICATIONS
a) Abdominal trauma and shock
b) Multiple trauma with head injury and decreased level of
consciousness
c) Multiple trauma with spinal cord injury
d) Acute pelvic fracture and hypovolemia
2) TECHNIQUE
COOK CATHETER TECHNIQUE
a)
Aseptic prep and technique
b)
0.5 cm skin nick made 1/3 distance from umbilicus to pubis in midline.
Alternative site is infraumbilical margin
c)
Inject lidocaine with epinephrine for hemostasis.
Needle
is introduced through the linea alba and peritoneum. It is important to
tent the anterior abdominal wall with towel clips while introducing the needle.
d)
The guidewire is introduced into the peritoneal cavity
e)
The needle is removed, leaving the wire
f)
The catheter is placed over the wire, and the wire removed
OPEN PERITONEAL LAVAGE TECHNIQUE
a)
Prep, aseptic technique, and lidocaine with epi as before
b)
1 ½ incision, vertically is made in the midline at the inferior umbilical
margin or at a third the distance between the umbilicus and the pubis
c)
The incision is carried to the linea alba with good hemostasis
d)
The linea alba is incised and the margins grasped with towel clips
e)
At this point the peritoneum may be visualized and incised or directly
punctured
f)
Direct the catheter into the lower left quadrant
ALL TECHNIQUES
800-900 cc
(10cc/kg) normal saline solution infused into the peritoneal cavity. At
this point the intravenous solution bag is lowered to the floor to allow the
infusate to return to the bag from the peritoneal cavity.
The color of
the returning infusate is inspected by holding the IV tubing to fine print to
determine whether the readability of the print is obscured by the depth of the
fluid discoloration. This visual technique gives a rapid clinical answer,
but an aliquot of fluid is sent to the lab for analysis. Positive criteria
are as follows:
1. RBC
count greater 100,000 cells/mm3
2. WBC
count greater 500 cells/mm3
3.
Vegetable fibers or stool present
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