- Site preparation
- Clean and drape the infraumbilical or supraumbilical midline site
- Infiltrate local anaesthetic down to fascia
- Open technique (classic approach)
- Make a 2 cm midline skin incision below the umbilicus
- Dissect down to linea alba
- Incise fascia and peritoneum carefully
- Insert a catheter or peritoneal lavage catheter into the peritoneal cavity
- Aspirate first:
- If gross blood, stop—this is a positive result
- If no gross blood, instill 500ml of warmed isotonic saline or Ringer’s lactate into the peritoneal cavity
- Gently rock the patient or wait a few minutes
- Allow fluid to drain passively or aspirate back via the catheter
- Interpretation
- Grossly positive
- Can see either blood, bile or enteric contamination
- Fluid is sent for analysis:
-
100,000 RBCs/mm³,
-
500 WBCs/mm³,
-
- Grossly positive
- Closure
- Remove catheter
- Close fascia with absorbable or non-absorbable sutures
- Skin closed with interrupted sutures or staples