Ministry of Health

http://newzealand.govt.nz/

    
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 Published: 28/11/2011

DPL

At Auckland Hospital, DPL is performed as an open, minor surgical procedure. It has been commonly undertaken in the ED for over 10 years. 

Technique

1. Ensure that the patient has a gastric tube and urinary catheter in place
2. Prep the abdomen with Betadine and drape the umbilical region.
3. Inject local anaesthetic with adrenaline in the midline subumbilical region (supraumbilical if pelvic fracture present).
4. Vertically incise the skin and subcutaneous tissue down to the fascia.
5. Insert a small self-retaining retractor to hold the tissues open and stop any bleeding.
6. Incise the fascia and identify the peritoneum. Insert a purse-string suture to stop leakage of lavage fluid.
7. Make a small hole in the peritoneum and insert the lavage catheter, directing it into the pelvis.
8. Connect the catheter to a syringe and aspirate.
9. If < 10mls of frank blood is aspirated instil 1 litre of warmed crystalloid and agitate the abdomen gently.
10. Allow the fluid to siphon off. At least 250mls must be removed for the lavage result to be representative.
11. Remove the catheter and suture the fascia and skin.

A positive lavage comprises:

1. Aspiration of >10mls of frank blood
2. A red cell count in the lavage fluid of >100,000/mm³
3. A white cell count of >500/mm³
4. Any bile or vegetable material in the lavage fluid.
5. Egress of lavage fluid via chest tube or urinary catheter.

Last updated on 28/11/2011