Chapter 133 - Peritoneal drainage technique

Question 1

What are the possible indications for peritoneal drainage?

Answer 1

• Septic peritonitis
• Bile peritonitis
• Uroperitoneum
• Pancreatitis-associated peritonitis
• Peritoneal dialysis
• Increased intraabdominal pressure
• Abdominal effusion compromising ventilation
• Abdominal effusion compromising patient comfort

Question 2

What are the different techniques of abdominal drainage?

Answer 2

Open peritoneal drainage (OPD)
Closed suction peritoneal drainage (CSD)
Primary closure

Vacuum-assisted drainage (VAD), under investigation in veterinary medicine

Question 3

What are the advantages of an abdominal drainage?

Answer 3

• Removal of fluid that may contain infectious agents, and foreign material (e.g., bile, ingesta)
• Removal of inflammatory mediators that may significantly impair humoral and cell-mediated immune mechanisms
• Alleviate increased intra-abdominal pressure (decreased venous return and cardiac output, hypovolemia and hypoxemia)
• Removal of bile salts, toxic for the mesothelial cells, altering host defense mechanisms and reducing phagocytic abilities of inflammatory cells in the peritoneal space
• Prevention of hypovolemia and hyperkalemia in uroperitoneum
• Peritoneal dialysis
• Cytologic analysis and monitoring (closed drainage)

Question 4

What are the advantages/disadvantages of an open peritoneal drainage (VS closed)?

Answer 4

• Indicated for a severe generalized peritonitis and/or severe contamination that cannot be resolved completely with debridement and lavage
• Effective and continuous drainage (no risk for catheter occlusion)
• Creation of an aerobic environment
• Reexploration before surgical closure
• No quantification of the abdominal fluid
• Nosocomial contamination
• Frequent bandage changes / Strict hygiene
• Evisceration
• Inflammation of the SQ and cutaneous tissue
• Need for another surgical intervention for abdominal closure

Question 5

What is the preferred recumbency for a paracentesis and preferred site of insertion of the needle?

Answer 5

Left recumbency (spleen), 2-3 cm caudal to the umbilicus, either on or slightly to the left of midline

Question 6

When is it recommended to remove the abdominal drains ?

Answer 6

• The drainage declines to acceptable levels (5 to 10 ml/kg q24h)
• Patient condition is improving
• Cytologic characteristics of the drain fluid show a resolving inflammatory response and no evidence of infection.

Question 7

What is the vacuum-assisted drainage technique?

Answer 7

VAD involves the application of controlled, evenly distributed subatmospheric pressure (75 to 125 mmHg) to the peritoneal space via a reticulated polyurethane foam.

Question 8

What are the complications inherent to all peritoneal drainage technique?

Answer 8

• Injury to internal structures
• Volume loss
• Protein loss
• Nosocomial infection