49084 Peritoneal lavage, including imaging guidance, when performed

Name of the Procedure:

Peritoneal Lavage Also known as Diagnostic Peritoneal Lavage (DPL)

Summary

Peritoneal lavage is a diagnostic medical procedure where a special fluid is introduced into the abdominal cavity and then removed to detect internal bleeding or injuries. This procedure often utilizes imaging guidance, such as ultrasound or CT scans, to ensure accurate placement and safety.

Purpose

Peritoneal lavage is primarily used to identify internal bleeding or injuries within the abdomen, typically following trauma or injury. The goal is to determine the presence of blood or other substances in the peritoneal space that may indicate damage to internal organs.

Indications

• Symptoms of abdominal pain or tenderness following trauma.
• Unexplained shock or drop in blood pressure following injury.
• Suspected internal bleeding that is not detectable through other diagnostic methods.
• Patient is unstable and unable to undergo other forms of imaging (e.g., CT scan).

Preparation

• Patient may need to fast for several hours prior to the procedure.
• Medications may be adjusted as advised by the healthcare provider.
• Blood tests and imaging tests might be required beforehand to assess the patient's condition.
• Consent form due to the invasive nature of the procedure.

Procedure Description

1. The patient is usually in a supine position and the abdomen is cleaned and sterilized.
2. Local anesthesia is administered to minimize discomfort.
3. A small incision is made and a needle or catheter is inserted into the peritoneal cavity.
4. Using imaging guidance (ultrasound or CT scan), the catheter is placed correctly.
5. A sterile fluid is infused into the cavity and then withdrawn.
6. The fluid is analyzed for signs of blood, bile, intestinal contents, or bacteria.

Duration

The entire procedure typically takes about 30 minutes to 1 hour.

Setting

The procedure is performed in a hospital setting, often in the Emergency Department or a dedicated procedure room.

Personnel

• Emergency physician or surgeon.
• Radiologist (for imaging guidance).
• Nurses and technician support for preparation and assistance.

Risks and Complications

• Infection at the insertion site.
• Injury to internal organs or blood vessels.
• Bleeding.
• Adverse reaction to anesthesia.
• False-negative or false-positive results that might require additional tests.

Benefits

• Quick and effective way to diagnose internal bleeding.
• Helps in deciding the next steps for treatment, including the need for surgery.
• Minimally invasive with relatively low complication rates.

Recovery

• Patients are usually monitored for a brief period after the procedure.
• Observation for any signs of complications, such as infection or bleeding.
• Most patients can resume normal activities within a few days, but follow-up appointments may be necessary.

Alternatives

• Abdominal ultrasound: Non-invasive but may not be as conclusive.
• CT scan: More detailed imaging but less suitable for unstable patients.
• Physical examination and ongoing observation.

Patient Experience

• The procedure is generally well-tolerated with local anesthesia used for comfort.
• Patients may experience mild discomfort or pressure during the insertion of the catheter.
• Post-procedure, mild soreness or bruising at the insertion site can occur but is usually manageable with pain medication and rest.