PERITONEAL

LAVAGE
By:
Jose Byron Dadulla-Evardone RN

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 Learning OBJECTIVE
 The Learner will be able to defined
purpose of Peritoneal lavage
 To know the steps and rationale of
Peritoneal lavage
 To identify the possible complication of
peritoneal lavage

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 Terminologies
 Diagnostic peritoneal lavage – instillation of
lactated ringer’s solution into the abdominal
cavity to detect red blood cell, WBC, bile,
bacteria, amylase, or gastrointestinal
contents indicative of abdominal injury
 Indwelling catheter - a catheter that
remains in the bladder either for a short
period to keep the bladder empty or for a
long time period to control incontinence,
prevent urinary retention or prevent leakage
of urine.
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Blunt trauma- to the abdomen is a major
component of traumatic injury and
can be deadly. Blunt trauma can occur during falls,
motor vehicle accidents, or severe blows to the
abdomen.

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 PURPOSE OF THE SKILL

 Peritoneal Lavage –
Washing out of the peritoneal cavity.
The procedure is a diagnostic as well as a
therapeutic technique following abdominal
trauma or inflammation
Is used as diagnostic procedure in a patient
with:

1.BLUNT ABDOMINAL TRAUMA

2.Detect bleeding in the Peritoneal
cavity
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 A. Assessment :
 Evaluate client status: level of consciousness: level
of alertness, previous experience with dialysis or
peritoneal lavage and understanding of and
familiarity with the procedure.
 Assess the need for Peritoneal lavage and type of
catherization ordered
Rationale : to ensure proper procedure is carried out
 Assess abdomen for any signs of infection or
inflammation. Ask client for any history of difficulty
with prior Peritoneal lavage if any
Rationale : allow detection of potential complication
 Watch out for indication of distress

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 B. Diagnosis
 Risk for infection, related to invasive
device
 Risk for impaired Skin integrity, related
to infection and pressure from catheter
 Risk for hypovolemia, related to
excess fluid drain
 Deficient knowledge , related to
insertion of catheter
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 C. IMPLEMENTATION- SKILLS/ STEP
WHAT YOU NEED???

1. Indwelling urinary catheter

2. Catheter insertion kit and drainage bag
3. Nasogastric tube
4. Gastric suction machine
5. Shaving kit

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 WHAT YOU NEED???
1. I.V pole
2. Macrodrip I.V tubing
3. I.V Solution ( 1L warmed, balance saline solution
usually LRS or NSS) – Rationale : to prevent patient
discomfort and abdominal pain and to dilate the
vessels of the peritoneum to increase urea clearance
4. Peritoneal dialysis tray
Peritoneal Lavage Tray: 1 Povidone-Iodine swabstick;1 Absorbent towel;1
Fenestrated drape;1 Lazarus Nelson catheter 9fr radiopaque w/guidewire;1
Syringe 5cc (Luer Lock);1 Needle 20G x 1 1/2";1 Needle 21G z 1 1/2";1
Needle 25G x 5/8";1 Needle 18G x 3";1 Syringe 10cc (Luer Slip);1 Scalpel
blade w/handle;3 Gauze pads;1 Bandage
5. Sterile gloves

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 WHAT YOU NEED???
11. Gown
2. Goggles
3. Antiseptic solution (Povidone iodine)
4. 1= 3 ml syringe (25 gauge 1” needle)
1= 30 ml syringe
1= 20G 1 ½ needle.
5. Bottle of 1% lidocaine with epinephrine
6. # 14 intracatheter extension tubing
[ length = 8 inch or 20.3 cm]
7. A small sterile hemostat [to clamp tubing]
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 WHAT YOU NEED???
1. Sterile towels
2. 3 sterile bottle container for specimen
collection and 1= sterile tube for a culture and
sensitivity specimen
3. Labels
4. Antiseptic ointment
5. 4x4 gauze pads
6. Alcohol pads
7. 1’’ hypoallergenic tape
8. 2-0 and 3-0 sutures

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 Special consideration
 If using a commercially prepared
PERITONEAL DIALYSIS KIT which
contains :
• #15 peritoneal dialysis catheter
• Trocar
• And extension tubing with roller clamp
 Make Sure The Macrodrip IV Tubing Doesn’t
Have A REVERSE FLOW(OR BACK-CHECK
VALVE)- it prevents infused fluid from
draining out of the peritoneal cavity.

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 Tell Client what to expect :
Before the procedure, advise the patient
to expect a
• sensation of abdominal fullness.
• Chills if lavage isn’t warmed or doesn’t reach
his body temperature

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 How do you do it ??
I.
Provide privacy
II.
Wash your hands
III.
Reinforce the doctor’s explanation of the
procedure
IV.
Put on the gown and goggles
V.
Catheterize the patient with the indwelling urinary catheter
and connect to the drainage bag
• RATIONALE : to prevent laceration or puncture of bladder

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 How do you do it ??
VI.
 Insert the NG tube . Attached this tube
to the gastric suction machine
( set for low intermittent suction)
RATIONALE:
1. to drain the patient’s stomach contents.
2. Decompressing the stomach prevent vomiting and
aspiration
3. Minimize the possibility of bowel perforation during trocar
or catheter insertion.
VII.
 Using the shaving kit, clip or shave the hair, as
ordered, from the area between the patient’s
umbilicus and pubis.

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 How do you do it ??
VIII.
 Set-up IV pole. Attached the
macrodrip tubing to the LAVAGE
solution container, and clear air from
the tubing
RATIONALE : to avoid introducing air into
the peritoneal cavity during the lavage.
IX.
 Using aseptic technique, open the
peritoneal dialysis tray.
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 How do you do it ??

X. DOCTOR TASK:
The doctor will wipe the patient’s
abdomen with the antiseptic solution
drape the area with sterile towels
• RATIONALE : to create a sterile field

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 How do you do it ??
X. NURSE TASK:

Using Aseptic Technique– hand the doctor the 3

ml syringe and 25G 1’’ needle

Important consideration: If the peritoneal dialysis

tray doesn’t contain a sterile ampule of
anesthetic----- wipe the top of multidose vial of 1
% lidocaine with epinephrine with an alcohol pad
invert the vial at 45 degree angle

• RATIONALE : Allows the doctor to insert the needle

and withdraw the anesthetic without touching the
nonsterile vial.
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 How do you do it ??
X. DOCTOR TASK:
Diagnosis:

Inject anesthetic below the umbilicus & he’ll make incision

Insert trocar or catheter

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 How do you do it ??
X. DOCTOR TASK:
Diagnosis:

Inject anesthetic below the umbilicus

Insert trocar or catheter

Withdraw fluid & check findings

Findings are positive Findings: fluid clear or looks normal

Procedure ends LAVAGE WILL CONTINUE

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Prepare for LAPAROTOMY
 How do you do it ??
Findings: fluid clear or looks normal LAVAGE WILL CONTINUE
XI. Implementation
 Wearing gloves ---- Connect the catheter
extension tubing to the IV tubing , if ordered
and still 500 to 1000 ml of warmed IV
solution into the peritoneal cavity over 5-10
minutes---- then clamp the tubing with
Hemostat.
Unless C.I = gently tilt the patient from side to
side
• RATIONALE : distribute the fluid throughout the
peritoneal cavity.

If tilting is C.I = may gently palpate the sides of

the abdomen
• RATIONALE: to distribute fluid
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 How do you do it??
XII .
after 5-10 minutes -----
Place I.V container below the level of patient’s
body and open the clamp on the IV tubing
• RATIONALE : Lowering the container helps excess
fluid to drain.
Gently drain as much as fluid as possible from
the peritoneal cavity to the container.
BE CAREFUL – not to disconnect the tubing
from the catheter
• DRAINING TIME : 20-30 minutes to complete

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 SPECIMEN
XIII .
 To Obtain fluid specimen:
Put on the gloves
Use 30 ml syringe gauge 20 1 ½ “ needle ( to
withdraw between 25 and 30 ml of fluid from a
port in the IV tubing.
Clean the top of each specimen container with
an alcohol pad.
Deposit fluid specimens in the labeled containers
and send the specimen to the laboratory
• NOTE : for C/S : change needle
– Rationale : to avoid contaminating the specimen.
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 AFTER CARE
XIV .
 The doctor will close the incision
 Nurse task :
wearing sterile gloves --- apply antiseptic
ointment to the site and dress the incision with
4x4 gauze pad
Discard the disposable equipment
Return reusable equipment to the appropriate
department for cleaning & sterilization.

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 AFTER CARE

XV.
 AFTER LAVAGE :
monitor the patient vital signs
Report signs and symptoms of shock
[ tachycardia, decrease BP,
diaphoresis, dyspnea and vertigo]
Assess the incisional site frequently for
bleeding.

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 D. EVALUATION
 Vitalsign was stable
 The catheter was inserted without
pain, trauma, or injury to the client
 The client’s bladder was emptied
without complication
 The nurse maintained the sterility of
the catheter during and after insertion .

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 Documentation
 After Peritoneal Lavage Record
Type and size of peritoneal dialysis catheter
used.
Type and amount of solution instilled into and
withdrawn from the peritoneal cavity
Amount and color of fluid returned.
Whether the fluid flowed freely into and out of
the abdomen
Specimen obtained and sent to the laboratory
Complication and nursing intervention.

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The End

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