Thursday, July 12, 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.

A good irrigating solution is one that is not expensive. The solution should also be clear to make sure that tissues can be seen. This makes it easier to differentiate between normal and dead tissue. Normal saline is usually the agent of choice because it does not contain any toxic products. As a matter of fact, all it has is sodium and chloride whose concentration can be equated to that in the body. The only setback could be the fact that it has no antibiotic properties whatsoever. Other agents available in the market include sodium hypochlorite, iodine and sterile water.

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.

Debridement requires enough pressures to ensure effective removal of all damaged tissue. Continuous and pulsed irrigation are the two main approaches for debridement. As the name suggests, the continuous procedure is done without stoppage until all the dirt has been washed away. On the other hand, the pulsed method is done with periodic breaks in between. At end of the day, regardless of what means was used, the outcome is usually similar.

While performing debridement, it is important that both the patient and caregiver are protected from getting infections. Any foreign devices such as cannulas and catheters should be well covered. The eyes and face of the healthcare provider are bound to be splashed on by dirty fluid if protective measures are not put in place. Ensuring that the eyes do not glare directly and close to the wound helps in protecting them against splashes. The face also needs to be well covered by protective masks and gloves. Gowning and gloving are also important in keeping splashes from getting to the skin.

Apart from controlling active bleeding of tissues, unclean wounds need to be irrigated to ensure they heal rapidly. Irrigating tissues that are still bleeding can result in fatal complications. Clots tend to form very rapidly and can easily be transmitted elsewhere in the body. A clot lodged in the lungs is dangerous because the affected person can develop respiratory distress.

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.

It is important to document in detail what was done during debridement. One should indicate what solution was used and how much of it. In addition, if the wound was stitched up immediately, this should be indicated. Sometimes the wound may require several dressing sessions to allow infection to clear before it is closed with stitches .




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