Wednesday, July 11, 2018

A Few Notes On Wound Irrigation

By Donna Cook


Certain unexpected events can cause one to damage their skin and deeper tissues. Road traffic accidents are among the common ways that people develop wounds. Gunshot wounds are common among people living in insecure areas where crime is rampant. One can also damage their tissues when they sustain burn wounds. Judicious wound irrigation is paramount to ensure that injured tissues heal properly.

The ideal solution for irrigation should be transparent, affordable and safe to use. Being transparent helps the doctor and nurse to see the tissues and debris clearly. Commonly used agents include normal saline, sodium hypochlorite, povidone iodine, sterile water, potable water and commercialized wound cleansers. Normal saline is the most commonly used because of its high safety profile. It contains the same concentration of sodium and chloride ions as that found in blood. However, it lacks antiseptic properties and therefore may not be effective in managing infected wounds.

Equipment used for irrigation include syringes, pressure canisters and traditional containers modified for cleaning under pressure. Canisters could be of the piston type or bulbous. They have the advantage of being simple, cheap and efficient.

Irrigation can be said to either be continuous or pulsed. Pulsed irrigation is done with periods of rest, perhaps to confirm whether the wound has been fully cleansed. Studies, however, reveal that the outcome is the same, regardless of what method has been used. Pressure during cleaning ensures that all the debris has been done away with.

Irrigation can be quite messy sometimes. Due to high pressures, one can get splashed on by infected fluid. Both the patient and the doctor should protect themselves from getting infected. The eyes, being the most vulnerable, should be protected by wearing goggles. The caregiver should also wear a special gown and gloves to ensure the skin is protected. Any intravenous lines present on the patient should be carefully covered to keep them from getting splashed onto.

Irrigation is indicated for all types of wounds, initially and after every dressing. Care should be taken when irrigating wounds that are actively bleeding because this stands a risk of dislodging any existing clots. It may also be unwise to actively cleanse tissues in cases where bone, nerves and vessels are exposed.

Irrigation is a very sensitive procedure for the patient as some of their normal tissues may end up being traumatized, resulting in immense pain. As such, the doctor should be caring enough to ensure their comfort. Tissues around the area are injected with a local anesthetic agent. Alternatively, the patient can be put to sleep medically if the debridement will be long and intensive.

In a nutshell, thorough irrigation is paramount to ensuring that wounds do not complicate. It also ensures that the injured tissues are renewed and the patient can be able to live a normal life again. It may be necessary to write down all the steps taken during cleansing to be used as reference during subsequent care of the wound. This includes indicating the kind of irrigant used, how much volume of it was irrigated and under what pressures.




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