Page 2195 - Cote clinical veterinary advisor dogs and cats 4th

Diagnostic Peritoneal Lavage 1093.e3

minimize the potential for trauma with • Gently rock the animal from side to side, Postprocedure
the sharp trocar. and gently massage the abdomen to promote • Monitor recovery from sedation/anesthesia.
VetBooks.ir within the abdominal cavity, along the • Attach a 6- to 20-mL syringe (depending on Alternatives and Their Relative
• Supportive care as indicated for condition
○ Final catheter placement should be
fluid dispersion. Reduce or avoid this step
if the patient’s abdomen is painful.
ventral midline adjacent to the urinary
Merits
bladder.
slowly (to avoid omental plugging) aspirate to
• Seldinger-type peritoneal dialysis/abdominal body size and fluid volume instilled), and • Percutaneous needle abdominocentesis
drainage catheter obtain the fluid sample for analysis. Replace ○ Technically easier to perform
○ Insert using the same anatomic markers. male adapter when completed. ○ Requires less equipment
○ Use the Seldinger technique of initial • Open stopcock to the collection system, and ○ Higher probability of a negative tap with
guide wire placement, dilation, and sub- allow gravity to drain the remaining lavage small fluid volumes or pocketed areas of
sequent catheter insertion along the guide fluid. Incomplete retrieval is likely due to disease
wire. partial absorption and ineffective retrieval. • Abdominal ultrasonography
• Over-the-needle IV catheter Maximum retrieval should be attempted. ○ Noninvasive
○ Make 2-4 additional side holes < 30% of Removal: ○ Allows visualization of the entire abdomen
the diameter of the catheter using a #10 • Cut the purse-string suture, and remove the and detection of small or pocketed areas Procedures and Techniques
blade. catheter. of fluid accumulation
○ Insert using the same anatomic markers, • Place a skin suture if the incision is > 5 mm. ○ Ultrasound-guided aspiration allows fluid
and advance the catheter off the stylet after • Maintain a sterile dressing and bandage over collection without risk of side effects
the body wall has been fully penetrated. the incision site for 12-24 hours. secondary to instillation of lavage fluid.
• Red rubber feeding tube technique Analysis: ○ Diagnostic accuracy is operator dependent.
Anchoring: • Evaluate color: clear fluid is not expected ○ Not available at all veterinary facilities
• Anchor the catheter in place using 3-0 when peritonitis exists. Flocculent fluid • Abdominal computed tomography scan or
or-2-0 nylon suture. A purse-string suture indicates possible peritonitis. Red fluid magnetic resonance imaging
should be placed in the skin, followed by indicates hemoabdomen. Green fluid likely ○ High diagnostic accuracy rate
a Roman-sandal/Chinese-finger-trap suture contains bile. ○ Typically requires anesthesia
pattern. • Perform packed cell volume (PCV) count: ○ Limited to referral institutions
• Attach the sterile collection system to the > 5% indicates significant hemoabdomen. ○ Expensive
catheter port. • Perform white blood cell (WBC) count: • Laparoscopy
3
• Apply a sterile dressing at the insertion site, normal is approximately 1000 cells/mm . ○ High diagnostic accuracy rate
followed by a bandage. • Perform cytologic examination of fluid for ○ Requires anesthesia
• CAUTION: An Elizabethan collar should be degenerative neutrophils, toxic change, ○ Expensive
used if the animal is left unsupervised at any intracellular bacteria, bilirubin crystals, ○ Not available at many veterinary facilities
time with the tube in place. neoplastic cells, and other abnormalities. • Exploratory laparotomy
Lavage: • Consider aerobic/anaerobic culture if septic ○ High diagnostic accuracy rate
• Instill 22 mL/kg of warm saline into the peritonitis is suspected. ○ Requires anesthesia
abdominal cavity through the 3-way stop- • Consider chemistry evaluation of lavage fluid ○ Highly invasive
cock. Closely monitor the cardiovascular and comparison with peripheral blood AUTHOR: Lillian I. Good, DVM, DACVECC
and respiratory status of the animal during ○ Elevated creatinine in lavage fluid indicates EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
infusion for early detection of deterioration ruptured urinary tract. Thompson, DVM, DABVP
warranting termination of the procedure. ○ Elevated bilirubin indicates ruptured
Place a sterile male adapter into the port biliary tree.
when completed to maintain a closed system. ○ Elevated amylase supports pancreatitis.

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