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1093.e2 Diagnostic Peritoneal Lavage

Diagnostic Peritoneal Lavage
VetBooks.ir

• Lavage fluid (typically lukewarm saline) and
Difficulty level: ♦♦
is infrequent but possible. Sterile technique
administration supplies that depend on the • Ascending infection into the peritoneal cavity
Synonyms volume of lavage infused (syringe/needle vs. must be maintained during placement and
Abdominal lavage, DPL fluid bag with drip set, 22 mL/kg) when manipulating the lavage materials.
A bandage should be maintained over
Overview and Goal Anticipated Time the catheter site, and the catheter should
Instillation and subsequent evacuation of lavage • About 15-40 minutes for placement be removed when the procedure has been
fluid to evaluate suspected intraabdominal • Additional time required for drainage completed.
disease depends on type of catheter selected, degree
of flow obstruction encountered, and varia- Procedure
Indications tion between animals. Patient preparation:
Animals with suspected abdominal disorders • Sedate the patient if it is fractious or likely to
for which other noninvasive/less invasive testing Preparation: Important struggle or if the clinician’s ability to maintain
has been inconclusive or unavailable. Animals Checkpoints a sterile technique throughout the procedure
that might benefit from diagnostic peritoneal • Ensure adequate manual or chemical is questionable.
lavage (DPL) include those with restraint. Excessive struggling by the animal • Empty urinary bladder through catheteriza-
• Abdominal trauma may result in contamination of the sterile tion or manual expression (decreases potential
• Acute abdomen field or increased risk of abdominal trauma for bladder trauma or laceration during
• Sepsis with no source identified during catheter placement. catheter placement).
• Shock with no source identified • Maximize cardiovascular stability before the • Place in dorsal recumbency. Left lateral
procedure. recumbency is also possible but not preferred.
Contraindications • Receive owner approval for invasive procedure. • Clip hair from abdomen, from xiphoid to
• Cardiovascular/respiratory compromise • Perform all abdominal imaging before the pubis.
that may be exacerbated by lavage fluid procedure because lavage fluid instillation • Surgical scrub
administration affects future imaging interpretation. • Determine catheter insertion sites for the
• Coagulopathy skin and body wall:
• Recent abdominal surgery Possible Complications and ○ Recommended skin insertion site is
• Diaphragmatic hernia Common Errors to Avoid 1-2 cm to the right of the umbilicus.
• Care must be taken during placement ○ Recommended body wall insertion site
Equipment, Anesthesia to avoid internal organ damage. Possible is 1.5-3 cm caudal to the skin insertion
• Minimum of two assistants traumatic injury includes site.
• Sedation may be necessary; local anesthesia ○ Vessel or organ laceration leading to • Administer lidocaine injection at skin and
and manual restraint sufficient for most hemoabdomen body wall insertion sites, penetrating all tissue
animals. ○ Gastrointestinal (GI) tract perforation layers to be incised. NOTE: Pain with lido-
• Hair clippers leading to septic peritonitis caine injection can be minimized by mixing
• Surgical scrub solution ○ Urinary tract laceration leading to lidocaine with one-tenth of the volume of
• Isopropyl alcohol uroabdomen 8.4 mEq/L sodium bicarbonate (adjusts to a
• Sterile gauze for scrubbing skin • Obstruction of catheter drainage holes with more neutral pH) and by warming to body
• Local anesthesia (2% lidocaine) omentum is a frequent occurrence and can temperature (e.g., once filled, keep syringe
• Sterile drape limit complete retrieval of lavage fluid. tucked in clinician’s axilla).
• Sterile surgical gloves Repositioning the animal and flushing the • Repeat surgical scrub.
• Sterile needle holders catheter may help relieve the obstruction. • Wear sterile gloves.
• Sterile scissors Use of commercially available peritoneal • Drape sterile field.
• A #11 blade for stab incision of skin dialysis catheters with numerous (50-100) Placement (technique varies depending on the
• Sterile drainage catheter: various devices can small-diameter side holes may minimize com- chosen catheter device):
be used: plete omental plugging. Cutting additional • Trocar-type peritoneal dialysis catheter
○ Peritoneal dialysis catheter (recommended) side holes (never more than one-third of the ○ Incise skin using a #11 blade: incision
○ Over-the-needle, large-gauge intravenous circumference because tube breakage may should be no larger than the catheter
(IV) catheter: may be prone to kinking occur) into a nonperitoneal dialysis–specific diameter.
○ Abdominal drainage catheter catheter can be performed to decrease plug- ○ Tunnel the catheter through the subcu-
○ Red rubber feeding tube ging of a single distal opening. taneous space to the desired body wall
• Sterile collection system consisting of ○ If sufficient lavage fluid cannot be entry site.
Christmas tree adapter, 3-way stopcock, retrieved, complications such as animal ○ Insert trocar and catheter through the body
IV drip set, and collection bag discomfort, cardiovascular or respiratory wall at a 45° angle, directed caudally.
• 2-0 or 3-0 nylon suture to anchor the catheter compromise, or overhydration may ensue. ■ A turgid abdomen allows easier
to the skin • Subcutaneous or external leakage of lavage placement.
• Bandage material fluid may occur, especially if the body wall ■ With a flaccid abdomen, insertion may
○ Nonadhesive absorbent sterile pad incision is large. Tunneling the catheter at be facilitated by grasping and tenting
○ Cast padding least 2 cm through the subcutaneous space the abdomen with one free hand while
○ Kling-type bandage roll helps minimize external leakage. Keep the advancing the catheter with another
○ Protective outer layer (e.g., Esmarch-type body wall and skin incisions small; the tube hand.
bandage [Vetrap]) should be inserted with a snug fit through ○ After passage through the body wall,
• Elizabethan collar the incisions. advance the catheter off the trocar to

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