critical care medicine
How To Do Diagnostic Peritoneal Lavage (DPL)
Introduction
Diagnostic peritoneal lavage (DPL) is an invasive emergency procedure used to detect hemoperitoneum and help determine the need for laparotomy following abdominal trauma. A catheter is inserted into the peritoneal cavity, followed by aspiration of intraperitoneal contents, often after their dilution with crystalloid. DPL is a rapidly performed bedside procedure using simple equipment that may detect hemoperitoneum or intraperitoneal contents. However, DPL is rarely done for the detection of intraabdominal bleeding in facilities where CT scans and How To Do E-FAST Examination are available. DPL has low specificity, identifying many lesions that cause bleeding but do not require operative repair, and results in a high negative laparotomy rate. DPL is invasive and risks iatrogenic damage to abdominal organs during the procedure. DPL also misses retroperitoneal injuries. However, DPL is more sensitive than E-FAST for mesenteric, diaphragmatic, and hollow viscus injury because these injuries (and the lesser volume of hemorrhage they produce) are more difficult to visualize on imaging. The most common DPL techniques are Closed: Percutaneous needle insertion into the peritoneal cavity followed by catheter-over-wire (Seldinger technique) Semi-open: Dissection down to (and sometimes through) the rectus fascia followed by needle and catheter-over-wire technique into the peritoneal cavity An open technique (mini-laparotomy) in which the operator dissects into the abdominal cavity to directly visualize the peritoneum and incise it to insert the catheter in a more directed fashion is less often done and is not discussed here. 