Note of caution on diagnostic peritoneal lavage

Jansen et al highlight the potential difficulty of diagnosing intraperitoneal bleeding and hollow viscus injuries in patients with blunt abdominal trauma.1 Despite an increasing use of point of care focused assessment with sonography for trauma (FAST), diagnostic peritoneal lavage continues to be taught on advanced trauma life support courses2 and can provide useful information that has the potential to alter patient management in appropriately selected cases. However, we wish to sound a cautionary note for physicians performing diagnostic peritoneal lavage.

Our department has previously surveyed a representative sample of 40 UK major trauma units regarding their ability to analyse fluid samples.3 During normal working hours (9 am-5 pm), only 29 of 40 haematology departments were able to provide this service, falling to nine of 40 outside these times. Fourteen departments stipulated that the lavage fluid should be collected in EDTA bottles, while the remainder had no container preference. We also detected variation in the returned volume of lavage fluid required for analysis, in the infusion fluid required, and in the time taken for sample analysis. Only five of 40 departments had guidelines in place. Given these findings we strongly recommend that prior to performing diagnostic peritoneal lavage, doctors confirm with their local laboratory service both the ability to analyse lavage fluid and any special requirements for sample handling. This seems particularly prudent outside of normal working hours.