WHATS BLACK-AND-WHITE AND RED (READ) ALL OVER - THE BEDSIDE INTERPRETATION OF DIAGNOSTIC PERITONEAL-LAVAGE FLUID

Diagnostic peritoneal lavage (DPL) is often used to determine whether a blunt trauma victim has significant intra-abdominal hemorrhage. One bedside test (BT) historically recommended to evaluate DPL fluid is th e ability to read newsprint through the fluid contained within intrave nous (IV) tubing. Few experimental data support this practice. Two hun dred eighteen traumatologists were queried regarding their use of BTs. In a related clinical study, blinded volunteers were asked to read pr int through various unmarked containers filled with simulated DPT, flu id, created by adding aliquots of whole human blood to liter bags of l actated Ringer's solution. Of the 97 traumatologists who completed our preliminary survey, 60 per cent reported using a visual BT to assess DPL fluid. Of these surgeons, 44 per cent attempted to read newsprint through IV tubing. Our clinical study showed that more volunteers coul d read print through a red top tube (95%) when it contained a red cell concentration of 827 +/- 41/mm(3) than the IV bag (4%). Nearly 70 per cent of volunteers were able to read print through the tubing contain ing 41,429 +/- 2,967 red blood cells (RBCs)/mm(3). Regardless of the r eceptacle, readability was lost at RBC counts far below 100,000/mm(3). Many traumatologists utilize BTs as an adjunct to clinical decision m aking, We conclude that, if the clinician can read print through lavag e fluid within an IV bag, Vacutainer tube, or IV tubing, the DPL will be negative at cell count. However, inability to read print through IV tubing requires laboratory confirmation to document an RBC count >100 ,000/mm(3).