Bagaimanakah pemeriksaan Diagnostic Peritoneal Lavage dan Laboratorium apa

yang di cek?
DPL is another rapidly performed study to identify hemorrhage. Because it can
significantly alter subsequent examinations of the patient, the surgical team caring for the patient
should perform the DPL. The technique is most useful in patients who are hemodynamically
abnormal with blunt abdominal trauma or in penetrating trauma patients with multiple cavitary
or apparent tangential trajectories. Finally, hemodynamically normal patients who require
abdominal evaluation in settings where FAST and CT are not available may benefit from the use
of DPL. In settings where CT and/or FAST are available, DPL is rarely used because it is
invasive and requires surgical expertise.
Relative contraindications to DPL include previous abdominal operations, morbid
obesity, advanced cirrhosis, and preexisting coagulopathy. An open, semiopen, or closed
(Seldinger) infraumbilical technique is acceptable in the hands of trained clinicians. In patients
with pelvic fractures, an open supraumbilical approach is preferred to avoid entering an anterior
pre-peritoneal pelvic hematoma. In patients with advanced pregnancy, use an open
supraumbilical approach to avoid damaging the enlarged uterus. Aspiration of gastrointestinal
contents, vegetable fibers, or bile through the lavage catheter mandates laparotomy. Aspiration
of 10 cc or more of blood in hemodynamically abnormal patients requires laparotomy.
Advantages :
• Early operative determination
• Performed rapidly
• Can detect bowel injury
• No need for transport from resuscitation area
Disadvantages :
• Invasive
• Risk of procedure-related injury
• Requires gastric and urinary decompression for prevention of complications
• Not repeatable
• Interferes with interpretation of subsequent CT or FAST
• Low specificity
• Can miss diaphragm injuries
Indications :
• Abnormal hemodynamics in blunt abdominal trauma
• Penetrating abdominal trauma without other indications for immediate laparotomy
Diagnostic Peritoneal Lavage (DPL)—Optional Skill
STEP 1. Obtain informed consent, if time permits.
STEP 2. Decompress the stomach and urinary bladder by inserting a gastric tube and urinary
catheter
STEP 3. After donning a mask, sterile gown, and gloves, surgically prepare the abdomen (costal
margin to the pubic area and flank to flank, anteriorly).
STEP 4. Inject local anesthetic containing epinephrine in the midline just below the umbilicus,
down to the level of the fascia. Allow time to take affect.
STEP 5. Vertically incise the skin and subcutaneous tissues to the fascia.
STEP 6. Grasp the fascial edges with clamps, and elevate and incise the fascia down to the
peritoneum. Make a small nick in the peritoneum, entering the peritoneal cavity.
STEP 7. Insert a peritoneal dialysis catheter into the peritoneal cavity.
STEP 8. Advance the catheter into the pelvis.
STEP 9. Connect the dialysis catheter to a syringe and aspirate.
STEP 10. If gross blood or organic matter is aspirated, the patient should be taken for
laparotomy. If gross blood is not obtained, instill 1 L of warmed isotonic crystalloid solution (10
mL/ kg in a child) into the peritoneum through the intravenous tubing attached to the dialysis
catheter.
STEP 11. Gently agitate the abdomen to distribute the fluid throughout the peritoneal cavity and
increase mixing with the blood.
STEP 12. If the patient’s condition is stable, allow the fluid to remain a few minutes before
placing the intravenous fluid bag on the floor and allowing the peritoneal fluid to drain from the
abdomen. Adequate fluid return is > 20% of the infused volume.
STEP 13. After the fluid returns, send a sample to the laboratory for Gram stain and
erythrocyte and leukocyte counts (unspun). A positive test and thus the need for surgical
intervention is indicated by 100,000 red blood cells (RBCs)/mm3 or more, greater than 500
white blood cells (WBCs)/mm3 , or a positive Gram stain for food fibers or bacteria. A
negative lavage does not exclude

Referensi :

American College of Surgeons. Committee on Trauma. (2018). Advanced Trauma Life

Support®, ATLS®. Student Course Manual. In Anaesthesia.