WEBVTT

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parent Neil Davidge may be indicated whenever a

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patient has suffered blunt abdominal trauma or where

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intraperitoneal hemorrhage cannot be ruled out because of

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impaired consciousness or inability to

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adequately examine the patient.

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The equipment necessary for peritoneal lavage

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includes a peritoneal lavage tray.

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Local anesthetic solution

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parent neo dialysis catheter with

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truecar and connecting tubing,

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A 10 CC Syringe one

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liter of Ringer's lactate solution with appropriate

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tubing and prep solution.

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The tray includes sponges

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and drapes,

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A # 11 Knife Blade and

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other equipment necessary for the procedure.

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Prior to the procedure,

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the troll car is placed within the

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catheter.

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This will provide rigidity and

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stability as it enters the peritoneal

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cavity.

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After removal of the truck.

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Are the appropriate connecting tubing

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and I?

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Ve to being are placed on the catheter

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to allow infusion of the ringer's

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lactate solution.

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The catheter is usually inserted at a 0.223

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centimeters below the umbilicus in the midline

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This region has relatively few blood vessels and is

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away from any of the major solid organs,

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pregnancy loops of

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dilated bow,

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surgical scars that might indicate adhesions

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or grossly dilated bladder are relative

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contraindications to the procedure.

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If any of these problems are apparent.

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Either an alternate site should be chosen or a

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more extensive incision made.

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Do visualize the peritoneum before placing

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the catheter.

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After a full skin prep and draping of the site.

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A local anesthetic is injected.

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A small stab wound is then made with a number 11

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blade,

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so as to provide a skin opening large enough to insert

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the Catheter.

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The catheter with stroke are in position is

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grass with two hands and pressed against the midline

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fashion at a slight angle,

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gentle pressure should be exerted until the catheter is

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forced through the fashion and into the peritoneal

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cavity.

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Success is usually accompanied by a

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popping sound.

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Once the peritoneum has been penetrated,

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the troll car is removed before advancing the catheter

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any further,

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The soft catheter is then gently advanced

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15-20 cm or until it meets firm

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resistance within the peritoneal cavity.

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If early resistance is appreciated,

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the trow car should never be used to force

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advancement of the catheter.

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Once the catheter has been placed,

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the connecting tubing,

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which is provided with the catheter is attached.

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A 10 CC Syringe is then used to

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aspirate any existing fluid or

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blood.

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If non clouding blood freely flows from the

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catheter or is easily aspirated,

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the tap is considered positive and the

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catheter may be withdrawn.

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If no blood is aspirated,

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1000 CCS of Ringer's lactate solution is

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running by gravity flow.

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The patient's abdomen should then be gently rolled to

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encourage dispersion of the solution throughout the

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peritoneal cavity modifications of

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fluid volume may be used for Children or for

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patients with head injury.

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The empty bag is then placed at a position lower than the level

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of the bed or stretcher and permitted to refill

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the recovery of fluid is always incomplete.

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However,

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as long as mixing is adequate.

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The retrieval of even a small amount of fluid will

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permit interpretation of the test.

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The following to live sequences will show the

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application of peritoneal lavage

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in trauma situations.

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Mhm.

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When dealing with a severely traumatized

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comatose patient,

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the procedure can be carried out very rapidly.

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Once the abdomen is prepped and draped,

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a small incision is made with the surgical

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blade.

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Yeah,

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please let down.

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Please please

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let down.

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Please.

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Could you put a

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catheter with stroke are in place,

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is then forced into the peritoneum.

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The truck are removed and the catheter

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advanced.

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The immediate return of frank blood in this

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patient is indicative of a positive tap.

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Therefore lavage need not be carried out in the

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catheter is removed.

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In the less urgent situation.

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The skin should be prepped and draped and the

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local anesthetic with epinephrine injected both

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superficially and deep.

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Uhh We have all right.

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I think you'll feel some pressure.

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Now.

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Following the skin incision with the surgical

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blade,

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Catheter with stroke are in place

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is again forced through the fascia into

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the peritoneal cavity.
128
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The

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truck car is removed as soon as it enters the

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peritoneum and the catheter is then

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advanced in order to

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aspirate any fluid.

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A connecting tube is

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attached to the catheter.

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I think so,

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yes.

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Leave alone man,

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I

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hey,

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will you please,

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you guys leave me alone man.

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How you know

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this small amount of blood which appears

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is not a positive tap.

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Right.

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Such a you.

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Therefore 1000

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CCS of Ringer's Lactate is

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running.

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Bye,

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gravity flow.

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Oh,

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oh

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where do you feel that

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the abdomen is gently agitated to

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distribute the infused fluid.

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So leave me alone.

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Man has to buy me but he was

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very enjoyable that well.

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The Infusion

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may take 5-7 minutes

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but should be relatively rapid.

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The bag is then placed at a position

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lower than the level of the stretcher and

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permitted to refill.

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Once a sufficient amount of fluid has been recovered

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the tube is removed and

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the simple dressing is applied.

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Eric I was trying to show you

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how you doing.

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Hey you see what?

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Oh

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oh it hurts.

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Yeah if the fluid return is

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completely clear it is safe to assume that the lavage is

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negative.

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Three CCs of blood have been injected into this bag of

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ringer's lactate to point out that even small amounts of blood may

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deeply colour the solution.

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It is important therefore to verify a positive

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lavage with a laboratory red cell count

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Account of 100,000 red cells per cubic millimeter

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of fluid indicates a positive lavage for

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intraperitoneal hemorrhage.

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Less common indications of a positive tap include the

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presence of bacteria,

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vegetable matter or fecal matter.

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On microscopic examination

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in summary.

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Then the steps of the procedure.

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Our first prep and drape the

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site

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inject a local anesthetic with epinephrine.

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3rd make a small incision at the site.

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4th insert the catheter and truecar

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combination

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remove the trow car.

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As soon as the penetration is made.

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Then connect the appropriate tubing.

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Aspiritech with a syringe,

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connect tubing and catheter to the bag and infuse

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the fluid,

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gently roll the abdomen to distribute the fluid

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and finally allow the fluid to return by

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gravity flow.

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The catheter is then removed

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and addressing applied.