What are the steps in wound irrigation?

Wound hygiene and closure techniques need not be sterile procedures. Although instruments that touch the wound (eg, forceps, needles, suture) must be sterile, clean nonsterile gloves as well as clean but not sterile water may be used in immunocompetent patients. Some operators prefer the better fit and better barrier protection of sterile gloves.

Clean procedure, barrier protection

• Face mask and safety glasses (or a face shield), head cap, gown, gloves (sterile if preferred, but these are nonsterile procedures)

• Sterile drapes, towels (for wound debridement and suturing)

Wound cleansing, inspection, debridement (not all items are required for simple repairs)

• Antiseptic solution (eg, chlorhexidine, povidone-iodine)

• Sterile gauze squares (eg, 10 cm × 10 cm [4 inch × 4 inch])

• Pneumatic tourniquet (or blood pressure cuff), commercial hemostatic agent, as needed to assist hemostasis

• For certain patients (eg, children), topical anesthetic (eg, proprietary emulsions of 2.5% lidocaine plus 2.5% prilocaine)

• Sterile saline for irrigation (sterile water or clean, potable water are permissible substitutes)

• 35-mL and/or 60-mL syringes

• Irrigation shield (syringe attachment to block splashing)

• Plastic catheter (eg, 18- or 19-gauge standard catheter) or commercially available splash guard device

• Fine-pore sponge (eg, 90 pores per inch)

• Tissue forceps (eg, Adson forceps), tissue hook, probe, hemostat, splinter forceps (fine-tipped), and suture scissors (single blunt-tip, double sharp edge)

• Scalpel (#10 for large incisions, #15 for precise incisions, #11 for small stab incisions), iris scissors, or curette

• Antibiotic ointment: Topical antibiotic ointments continue to be recommended for sutured wounds because they help keep wound edges moist and prevent dressings from sticking. However, they have not been proven to reduce infection or enhance healing.

• Sterile nonadherent, absorbent, and/or occlusive dressing

• Gauze roll and tape or gauze sleeve

• Sometimes splints or other materials to restrict motion or skin tension that may pull on the wound

Wound irrigation may sometimes be performed under local anesthesia or sedation, depending on the extent of the wound. The wound is assessed by the doctor, and an appropriate solution and amount of solution are selected for wound irrigation. The procedure is performed under strict aseptic conditions. A large, wide-bore syringe is held just above the edge of the wound, and the solution is instilled into the wound, slowly and continuously with a minimal force that is just enough to flush out the entire wound. If too much force is applied, the solution could get pushed into the pockets of the wound, causing complications. The irrigation procedure may be repeated until the wound is completely clear. Wound debridement may be performed after wound irrigation. The wound is wiped dry, and appropriate dressing is applied.

What is wound irrigation?

Wound irrigation is a non-invasive procedure in which a steady flow of a solution is used to achieve wound hydration; remove debris, dead cells, pathogens, and excess blood or other exudates such as pus in an open wound; and assist with a better visual examination. Wound irrigation is one of the most effective methods of wound cleansing.

Wound debridement may be combined with wound irrigation. Wound debridement is the process of removing necrotic (dead) tissue from the wound. Wound irrigation, with or without debridement, can aid in wound healing and prevent premature surface healing over an abscess or a foreign body, reducing the recurrence. The goal of wound irrigation is to clean the wound and decontaminate it, reducing the risk of infection or worsening infection, without creating anymore trauma to the wound.

What are the solutions used for wound irrigation?

There are various solutions that can be used for wound irrigation, depending on the wound. Solutions that may be used are topical cleansers, antiseptics, antibiotics, antifungals, and anesthetics.

• Normal saline: Normal saline is the most commonly used solution for wound irrigation. It is the safest, inexpensive, and easily available. It may be used on simple wounds with minimal contamination. Saline can’t thoroughly cleanse dirty or necrotic wounds. 
• Sterile water: Sterile water is frequently used to irrigate wounds. It is easily available and even cheaper than saline. Sterile water is hypotonic, meaning it would get absorbed by the cells; hence, if excess volumes are used, the tissues swell up due to water.
• Potable water: Potable water may be used when normal saline or sterile water is not available. It may be used to clean simple wounds that aren’t contaminated.
• Povidone-iodine: Povidone-iodine is an antimicrobial solution that is broad-spectrum and effective against various pathogens. There is a risk of damage to healthy cells and tissues due to povidone-iodine. Povidone-iodine causes a yellowish-brown discoloration of the skin when it dries. 
• Hydrogen peroxide: Hydrogen peroxide is a commonly used antiseptic, and it is usually diluted with saline. It can help remove dead tissues and debris and control active bleeding from the wound. Hydrogen peroxide is not known to be effective against microorganisms. There is a small risk of damage to healthy cells.
• Sodium hypochlorite: Sodium hypochlorite is usually used for cleaning pressure ulcers with necrotic tissue. It is effective against most organisms found in open wounds and reduces foul odor from an infected wound. The solution can cause damage to the healthy tissues; hence, it’s advised not to use it for more than 7-10 days.
• Commercial wound cleansers: Commercial wound cleansers are available over the counter at drug stores. They can remove debris, pathogens, or dead cells. They usually contain preservatives that slow the growth of bacteria and fungi and extend shelf life. They may not be effective in killing all pathogens.

What are the complications of wound irrigation?

Wound irrigation may cause the following complications:

• Excoriation (erosion due to loss of tissue)
• Increased pain
• Increased swelling 
• Bone damage, infection, and delayed healing due to high-pressure irrigation in bone and joint surgery
• Surface contaminants penetrating deeper layers due to high-pressure irrigation

Medically Reviewed on 10/19/2020

References

https://emedicine.medscape.com/article/1895071-overview#a1 https://www.sciencedirect.com/topics/medicine-and-dentistry/wound-irrigation https://www.ncbi.nlm.nih.gov/books/NBK538522/