peritoneal lavage test

The peritoneal lavage test was performed according to the following principle. Abdominal internal organs rupture, perforation, due to blood, gastrointestinal contents and gas into the abdominal cavity, produce peritoneal irritation, and diagnosed abdominal puncture, according to the nature of the liquid can be judged bleeding and cavity organ rupture. However, sometimes the amount of bleeding is small, or the gastrointestinal contents are less spilled, and the liquid can not be pumped when the abdomen is worn. At this time, a certain amount of liquid can be injected into the abdominal cavity, and then extracted, and the damage property is initially determined according to the change of the lavage fluid. . Basic Information Specialist classification: Digestive examination classification: other examinations Applicable gender: whether men and women apply fasting: not fasting Analysis results: Below normal: Normal value: no Above normal: negative: This experiment is negative for normal values, but pay attention to false negatives. Therefore, the elimination of false negatives is required. There may also be false positives and the test is positive and further tests should be performed to rule out false positives. Positive: Abdominal visceral injury, lesions, according to the positive findings to determine the damage, the type of organ of the lesion, multiple organ damage, there will be a variety of positive performance. Tips: Pay attention to the normal diet and work schedule, and actively cooperate with the doctor's examination. Normal value This experiment is negative for normal values, but pay attention to false negatives. Therefore, the elimination of false negatives is required. There may also be false positives and the test is positive and further tests should be performed to rule out false positives. Clinical significance Abnormal result Abdominal visceral injury, lesions, according to the positive findings to determine the damage, the type of organ of the lesion, multiple organ damage, there will be a variety of positive performance. 1. Meet the positive criteria of the first and fourth paragraphs in the examination method, suggesting that the liver, spleen and other substantial organs or blood vessels rupture. 2. In accordance with the second method of the examination method, the gallbladder or high intestinal rupture is indicated. 3. In accordance with the third method of the examination method, the stomach, intestinal rupture and perforation are indicated. 4. In accordance with the fifth and sixth paragraphs of the examination method, the indication is suppurative lesions, or have been combined with infection. 5. When the effluent of the catheter or chest drainage tube meets the above changes, it indicates that there is a rupture of the bladder or diaphragm. The people who need to be examined: 1. Closed abdominal injury. 2. Combined abdominal injury of brain and spinal cord injury. 3. Childhood abdominal damage. 4. Suspected organ rupture, perforation of acute abdomen. Positive results may be diseases: acute suppurative peritonitis, liver trauma, small intestine rupture, bladder injury, spleen rupture Forbidden before examination: pay attention to normal diet, pay attention to normal work and rest, and prevent endocrine disorders. Requirements for inspection: Actively cooperate with the doctor's request. 1. The results of this test should be combined with the characteristics of the eluate and other inspections, and comprehensive analysis. 2. Smaller trauma in the abdominal cavity, bleeding that has stopped, and false negative test results may occur. 3. Because of the incision of the abdominal wall, the insertion of the drainage tube can cause a small amount of bleeding, so there may be some false positive test results. Inspection process Method 1: Incision method 1. Abdominal radiation fluoroscopy and ultrasound examination before the test. Empty the bladder, abdominal distension and gastrointestinal decompression. Instigators, pediatrics can be applied sedatives. 2. The test can be performed in the observation room or ward, and the patient takes the supine position. 3. Abdominal skin routine cleaning and disinfection. 4. Incision position selection, generally take the midline, the umbilical and pubic symphysis line, the middle 1/3 intersection, that is, 4cm-6cm below the umbilicus. There are surgical scars in the lower abdomen and pelvic fractures. The incision position can be selected from the left abdomen or the upper abdomen. 5. Under the local anesthesia, cut the layers of the abdominal wall, the incision is 1, 2 cm long. Insert the abdominal dialysis tube, the tip points to the pelvic cavity, insert about 15cm, according to the size of the body, the thickness of the abdominal wall increases or decreases as appropriate. The peritoneum is sutured. 6. Pumping through the inserted catheter, such as withdrawing non-coagulated blood or gastrointestinal contents, no need to perform lavage tests, such as gastrointestinal contents or blood, or only less than 10ml of coagulative blood, then A lavage test was performed. 7. Connect the dialysis tube with an infusion set and quickly drip in saline or Ringer's solution. The adult dose is 1000ml and the child is 15ml/kg-25ml/kg. 8. After the instillation, turn the body up and down and left and right to fully flush all parts of the abdominal cavity, then lower the upper end of the infusion tube to below the bed surface, and use the siphon principle to take out the lavage fluid and collect it in a clean transparent glass bottle. 9. Observe the color and traits of the eluate and take a small amount for laboratory examination. Method 2: Puncture method 1. Same as method 1, item 1 - item 3. 2. The puncture point is selected in the same way as method 1. After local anesthesia, the abdominal wall was punctured with a trocar No. 18-20, and the needle core was withdrawn after the feeling of falling, and the plastic needle sheath was further advanced, and the plastic tube of the side hole was also inserted. 3. Same as method 6-6 items. The result is judged: The eluate is positive for one of the following: 1. The appearance of the eluate is bloody or bright red. 2. The appearance of the eluate is green, yellowish green (including bile). 3. The appearance of the eluate is turbid, with gastrointestinal contents, or microscopic examination of food residues and plant fibers. 4. The eluate microscopic examination red blood cell count>0.1×1012/L (100,000/μl). 5. Washout microscopic examination of white blood cell count > 5 × 109 / L (5000 / μl). 6. The eluate smear microscopic examination has a large number of bacteria. 7. Eluate amylase > 175 u / L. 8. The peritoneal lavage fluid flows out of the chest drainage tube or catheter. Not suitable for the crowd Inappropriate crowd: 1. There is a pulsatile mass in the abdominal cavity. 2. High abdominal distension can not be relieved. 3. A number of previous history of abdominal surgery. 4. Pregnancy. 5. Can not rule out suppurative lesions in the abdominal cavity. Adverse reactions and risks Nothing.

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