Peritoneal Lavage

Open technique

1. Sterile precautions
2. Catheterise bladder, decompress stomach.
3. Prep abdomen
4. Inject local midline & just below umbilicus (lidocaine with epinephrine to avoid blood entering).
5. Vertically incise skin/subcut tissue to fascia.
6. Grasp fascial edges with clamps, elevate and incise fascia down to peritoneum.  Nick it, entering cavity.
7. Insert a peritoneal dialysis catheter, and advance it to pelvis.
8. Connect to a syringe and aspirate.
9. If no gross blood aspirated (>few mls), instill 1L warmed Ringer's lactate (or N saline or 10ml/kg in a child) though IV tubing.
10. Gentl agitate abdo, mixing fluid with any blood.
11. Sit for a few minutes (if pt stable) before draining). Drain by put Ringers/N saline container (vented) on the floor and allowing fluid to drain.Adequate return is >30% of infused volume.
12. Send for Gram stain and cell counts.  +ve test and need for surgery if 100,000 RBCs/mm3 or more / >500WBCs//mm3 or +ve gram stain for food or bacteria.
Negative lavage does not exclude injury to retroperitoneal structures or diaphragm.

Complications
1. Haemorrhage with false +ve.
2. Peritonitis due to intestinal perforation
3. Laceration of urinary bladder
4. Injury to other abdo structures.
5. Wound infection (late complication)