King Saud University

College of Nursing

Di agnosti c
Peri toneal La va ge
(DP L)
Hatem Alsrour
Pu rpose of DP L
 Trauma
 Intraabdominal hemorrhage
 Visceral injury
 Perforation
 Other indications
 Pancreatitis
 Peritonitis
 Strangulating bowel
 Intestinal obstruction
 Malignant cells in peritoneal washing
What d o y ou need??

 Arrow DPL kit (found in each trauma room)

 Sterile gloves, gown, box of 4x4 gauze, pkg of sterile
towels
 Cleaning agent- Povidone iodine or chlorhexidine
 Warmed 0.9% saline solution or Ringer’s lactate
(physicians choice)
 Patient labels, requisitions and specimen tubes
 (1) no. 11 blade and (1) no. 15 blade
 1% or 2% lidocaine with epinephrine
Pr epara tio n a nd Set-u p
 Obtain appropriate consent.
 Ensure that the patients stomach and bladder are
decompressed.
 If needed place orogastric (OG) or nasogatric (NG) tube to
decompress the stomach and a foley to drain the bladder.
 This will avoid puncturing the bladder or bowel.
 Place patient on a full monitor to record vital signs
during procedure.
 Assemble appropriate supplies.
 Establish sterile field.
 Assist MD by setting up lavage equipment.
 This ensures that the warm fluid is available as soon as
catheter is placed and that a closed system is quickly
established.
 Assist with the administration of lidocaine.
 MD performs the
initial tap to access
the peritoneal space
and to assess
abdominal pathology.
 Initial aspirate is
drawn, labeled
appropriately and
sent to the lab.
 If the tap is dry (no fluid
was obtained) a small
incision may be made at
the linea alba. This will
facilitate catheter insertion.
 After insertion of the
catheter IV tubing and fluid
are attached. Fluid can be
instilled with a syringe or
by gravity.
 10-20ml/kg to a max of 1L.
 The fluid is used to rinse
the peritoneal cavity.
 Fluid is drained out of
the peritoneal cavity by
placing the IV fluid bag
in a dependent position
 After all fluid has been
removed the MD will
remove the catheter and
suture the incision
 Remove ~20cc fluid from
the return, place in
specimen tubes and
send to lab for analysis
How d o I k now if my
DPL is posi tive ??
 Grossly bloody fluid
 Red blood cell (RBC) count greater than
100,000/mm3. The threshold may be smaller for
a patient with penetrating trauma to the
abdomen or chest.
 White blood cell (WBC) count greater than
500/mm3.
 10ml of blood or enteric contents (stool,
food, etc.) constitutes a positive DPL, and
operative exploration is warranted. Other
positive findings include more than 100,000
RBCs/ml, 500 WBCs/ml, and amylase 175
IU. Lower thresholds may also be used,
which will result in fewer false-negative
tests, but increase the rate of negative
laparotomy. Levels of 10,000 RBCs/ml are
typically used in cases of penetrating trauma
 Presence of bacteria, bile, stool or amylase
in the abdominal fluid.
If yo ur DPL is posi tive .
. .
Prepare the patient
for the Operating Room

A positive DPL indicates intraabdominal

injury that requires surgical intervention.