Open vs. closed peritoneal lavage in abdominal trauma – Tips from Other Journals
Hemorrhagic shock is the most common cause of death related to motor vehicle accidents and blunt trauma. Peritoneal lavage has improved the probability of diagnosing intra-abdominal hemorrhage before the effects of hemorrhagic shock become obvious. The advantages of peritoneal lavage are that it can be performed’ quickly, accurately and with few complications. Troop and colleagues assessed the accuracy of open and closed peritoneal lavage in the evaluation of patients admitted to a trauma center.
The study included 220 patients who required peritoneal lavage. Patients were assigned to one of two trauma teams. The first team performed open lavage for one month and then switched to closed lavage. The second team performed closed lavage for the first month and then switched to open lavage. The closed lavage technique was performed by perforating the peritoneum with a needle, passing a guidewire through the needle into the abdomen, and then passing the lavage catheter over the guidewire after removing the needle. A lavage was considered positive if more than 10 mL of blood was aspirated after catheter introduction or if the red blood cell count in the lavage effluent was more than 100,000 per [Micro]L. All patients with a positive lavage underwent celiotomy.
The authors recorded positive lavage results and complications. They also measured length of time required for catheter insertion, length of time for fluid retrieval, volume of effluent, technical difficulty of lavage, training level of the surgical resident, red blood cell count in the effluent and material costs.
No differences were noted between the two procedures in the complication rate, volume of effluent or length of time for fluid retrieval. Closed catheter insertion required less time to perform than open catheter insertion (3.6 minutes versus 6.9 minutes). Material costs were lower for closed lavage than for open lavage ($69.70 versus $96.26 ). Surgical residents had less difficulty with catheter insertion using the closed lavage method.
The authors believe that closed peritoneal lavage is superior to open peritoneal lavage in the evaluation of patients with abdominal trauma. In addition to being as safe as open lavage, closed lavage is faster, easier to perform and less expensive. (Annals of Emergency Medicine, December 1991, vol. 20, p. 1290. )
COPYRIGHT 1992 American Academy of Family Physicians
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