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.