Palmer's test is a procedure used to verify the correct placement of a Veress needle before insufflation during laparoscopic surgery. It involves using a sterile, disposable syringe filled with normal saline to check for free flow in the peritoneal cavity.
How Palmer's Test Works
Palmer's test is a vital step in ensuring patient safety during laparoscopic procedures. Here's a detailed breakdown:
Step-by-Step Procedure
- Preparation: A resistance-free, disposable syringe is filled with 5 ml of normal saline.
- Attachment: The filled syringe is then attached to the Veress needle, with the flow tap of the needle open.
- Aspiration Check: The syringe is aspirated (pulled back slightly) to confirm the needle is not in a blood vessel or the bowel. Absence of blood or faecal matter is key.
- Saline Injection: 5 ml of sterile saline is then injected into the peritoneal cavity through the Veress needle.
- Resistance Check: The saline injection should flow easily with minimal resistance if the Veress needle is correctly positioned. Significant resistance suggests the needle might be in the wrong place, such as in subcutaneous fat or an organ.
Importance of Palmer's Test
- Safety: The test is a crucial safety step. It helps prevent serious complications during laparoscopic surgery, such as organ perforation.
- Confirmation: The free flow of saline confirms the Veress needle is correctly positioned within the peritoneal cavity before insufflation of the abdomen.
- Reduced Risk: It reduces the risk of insufflating air into an incorrect space which could cause complications.
Practical Insights
- Always use a resistance-free, disposable syringe to ensure accurate readings.
- Aspirate before injecting to check for the presence of blood or bowel contents.
- Minimal resistance to the saline injection is the key indication of correct placement.
Summary of Palmer's Test
| Feature | Description |
|---|---|
| Purpose | To check correct Veress needle placement before abdominal insufflation. |
| Materials | 5 ml disposable syringe, normal saline, Veress needle. |
| Procedure Steps | Attach saline-filled syringe to Veress needle, aspirate, inject saline, check resistance. |
| Positive Result | Free flow of saline with minimal resistance. |
| Negative Result | High resistance to injection, presence of blood or faecal matter on aspiration; indicates incorrect needle placement. |
