Peritoneal Lavage

[GleeGum, BSN, RN]

I'm filling out skills check lists because I really want to do travel nursing and I keep seeing peritoneal lavage. I know it was on the CEN as well, but I work in a Level I trauma Center and have yet to see it done, or even have them consider it as an option. It seemed to me that they are not specific and that CT and a FAST exam are much more accurate. So I am curious, does it happen in your ED?

[Be_Moore]

Also work in a Level I trauma and I don't think it happens in our ED either. Seems very old school. We do FAST and CT's. I suppose the option to do so is there, but.

[Medic09, BSN, RN, EMT-P]

With the widespread advent of bedside ultrasound, it is a far less encountered bird.

[bjaeram]

I've seen it done once and I'm still not really sure why they chose to do it. Pretty much everyone goes to CT. We don't do the ultrasound thing much either which I find strange. I think that would be the fastest and easiest route to look without even moving the pt but for some reason our docs are comfortable with it.

[Guest219794]

I am travel nursing. with 5 years experience, it's not a skill I have. Nobody has expressed concern.

[ACRN06]

And just to add, I just wanna make sure you understand it right.

Don't worry if you haven't done everything on those checklists. Its not a "checklist" in the sense of "you must have completed all these skills before travel nursing", it's more just to see where you are. I've never been asked about information on those things. I haven't done all the skills on my checklists either (having been at a Level II), it never held me back from travel jobs.

Just FYI :)

[GleeGum, BSN, RN]

Thanks everyone for the feedback. That was my impression.

and I agree that a bedside FAST is important. Had a Trauma the other day who was stable originally, with a small head bleed and a slight pericardial effusion noted on the FAST. effusion turned to tamponade and PEA (5 times!) and he got a pericardial window.

[astn]

While it's unlikely you'd ever see this done, it's even less likely at a "real" trauma center. It's an ATLS skill solely for the sites that don't have ultrasound (much less CT) available. That said, as far as a diagnostic skill goes it it pretty worthless. If there is a high suspicion of an ABD bleed, you'd be better off sending it out anyway as once you perform a peritoneal lavage, you've just killed those other two tools (which will give much better, more complete information anyway.)

From a historical standpoint, however, it's an interesting skill. It makes you appreciate the technology we have now.

[JStyles1]

ive seen it done twice through the umbilicus at the level 1 i used to work at

[Jennifer, RN]

This is a procedure that we ER nurses yearn to see performed, kind of like seeing a chest cracked (which is much more likely, of course, than a peritoneal lavage).

I have worked ER, level 2 trauma center, and have never seen this. Though, I did hear that it was performed at one time on one of my days off, making me insanely jealous. lol.

[LLLLiiiFFEsaveer]

I have seen this procedure done once too.

The surgeon thought he saw something on the US. Then, he immediately turned around and asked us for the DPL tray. I don't know the exact reasoning for the DPL with this one? I can tell you what I think though... This patient was very very obese, and I remember the surgeons quickly discussing what they thought they were seeing on the FAST exam... It seemed to me that they all thought they were seeing something very threatening, but the patients size made the US unreliable, and they wanted to know right then and there, if there was any blood in the abdomen? The diagnostic peritoneal lavage turned out negative. I haven't seen or heard of this procedure since. I just thought I would share the experience.