Overview of Wound Irrigation
Wounds and cuts are common reasons why people visit emergency or urgent care centers. Every year, around 12.2 million people in the United States visit these medical facilities to get their wounds treated or closed. The most frequent issue that can arise when caring for a wound is infection, with serious infections affecting roughly 2.47% of wounds that are stitched up in the emergency department.
Cleaning a wound with a special solution, also called wound irrigation, is a very important part of wound care. It’s the single most effective step in reducing the chance of your wound getting infected. The purpose of wound irrigation is to remove any foreign items, decrease the number of bacteria in the wound, and clean off any cellular debris or discharge from the wound surface.
It’s important to note that this process needs to be vigorous enough to achieve these aims, but also gentle enough to avoid causing more damage to the tissue or pushing bacteria and foreign material further into the wound. Since this process may cause body fluids to splash or spray due to the use of pressure, it’s essential for medical professionals performing the wound irrigation to wear appropriate protective equipment for their safety.
The process of wound irrigation involves several important steps, including assessing the wound, numbing the wound area, cleaning the skin around the wound, and irrigating, or cleaning, the wound with a solution that is applied under pressure.
Anatomy and Physiology of Wound Irrigation
Your skin is made up of two main layers: the epidermis and the dermis. The epidermis is the outer layer made of skin cells, and the dermis is the layer beneath the epidermis, which is made of a type of strong, fibrous tissue and contains important structures like blood vessels, hair roots, and sweat glands.
Below the dermis, you have another layer called the hypodermis, which is mostly made of loose tissue and fat. And even deeper under your skin, you will find muscles, tendons, which connect muscles to bones, ligaments, which connect bones to each other, as well as bones and cartilage, a flexible tissue found in various parts of the body.
Why do People Need Wound Irrigation
Washing out or “irrigating” a wound is an important step in handling both new (acute) and long-standing (chronic) wounds. This is particularly the case for wounds that will need stitching, surgical fixing, or the removal of dead, damaged, or infected tissue, also known as “debridement”.
When a Person Should Avoid Wound Irrigation
Cleaning out a wound, also known as irrigation, may not be needed for specific areas that have a lot of blood vessels, like the scalp. If a wound has channels called fistulas or passages referred to as sinuses, and if doctors don’t know how deep these go, they should carefully check the wound before deciding to clean it. This is because the cleaning process could accidentally push germs and dirty fluids further into the wound or other parts of the body.
Equipment used for Wound Irrigation
When doctors clean injuries, they use several methods that involve different kinds of tools. One option uses a large syringe (35-50mL) with a special eye cup on the end. This setup helps to clean the area while also stopping the cleaning liquid from splashing back. Another option uses a slightly smaller syringe with a 19-gauge (G) catheter. This combination can create the pressure needed to get rid of any debris and lessen the number of bacteria in the wound. Other clever strategies include using a large bag of isotonic liquid (a liquid with similar concentration to body fluids) hooked onto an IV (intravenous) pole with a larger catheter attached to it. Another straightforward method uses the same type of catheter, but this time with small holes punctured into the lid of a cleaning liquid bottle. By squeezing the bottle, you can generate the necessary pressure to clean the wound.
Doctors must wear protective equipment when cleaning and tending to wounds. This includes washing hands thoroughly, wearing gloves, a face mask, and protective eyewear. This helps to avoid accidentally infecting the wound, while also protecting the doctor from getting in contact with body fluids.
Numbing the wound area is possible with injections of lidocaine (a numbing agent), either alone or combined with epinephrine (a substance that narrows the blood vessels). Another option is bupivacaine (another numbing agent). They can also apply a topical solution which includes lidocaine, epinephrine, and also tetracaine (another type of numbing agent).
There are several wound cleaners available:
- Povidone-iodine Solution: This is highly effective at killing a broad range of bacteria, though it can slightly damage healthy cells and healing tissues.
- Chlorhexidine: Highly effective at killing bacteria common to the skin, but is less effective against bacteria that are harder to kill.
- Poloxamer 188: Doesn’t kill bacteria, but works like soap to remove dirt and oil.
Doctors also have different solutions they can use to irrigate, or clean out, wounds:
- Normal Saline: Non-toxic and similar in concentration to body fluids; most commonly used.
- Sterile Water: Non-toxic but may cause cells to burst due to being less concentrated than body fluids.
- Potable Water: Used when no other option is available and doesn’t seem to affect infection rates compared to using sterile water.
Who is needed to perform Wound Irrigation?
Cleaning a wound, also known as ‘wound irrigation’, can usually be done by one person. However, for bigger wounds or those in hard-to-reach areas, an extra person may be needed to help. This second person can help get the patient into a better position or adjust the wound so it’s easier to see. All kinds of medical professionals, from doctors to nurses, and even medical students can clean wounds successfully.
However, in situations when the wound is more complicated, such as having extra channels or tunnels (known as ‘fistulas’ or ‘wound tracts’), or the depth or path is unknown or tricky to determine, it’s best to have a more experienced provider, such as a specialist doctor, look at and clean the wound.
Preparing for Wound Irrigation
Before starting a wound cleaning process, it’s important that the patient understands and agrees to the steps involved. This includes checking the wound, numbing the area, cleaning the wound, and washing it out. The doctor will explain the potential risks and benefits of these steps to the patient. The patient’s known allergies need to be taken into account to avoid any reactions to the medicines or substances used during the cleaning. The patient will be positioned comfortably for the procedure, and the doctor will ensure they are also positioned in a way that makes the procedure easy to perform. It’s also mandatory that the doctor wash their hands prior to starting.
It isn’t always possible to numb the wound entirely, but a local anesthetic will be used to help make the cleaning process easier to tolerate. The area around the wound will be cleaned starting at the center and moving outwards in circles. To prevent water from spilling onto the floor or bed, absorbent pads are placed beneath the patient.
The doctor will wear personal protective gear, which includes shields for their eyes and face, a gown, and gloves. This is done to reduce the chance of exposure to any harmful germs that could be present in the blood.
How is Wound Irrigation performed
Let’s talk about a common method used to clean wounds, called the piston syringe technique. This can be done in just about any setting and uses tools that most medical clinics have.
The piston syringe method involves using a big syringe, about 35 to 50mL in size. This syringe can be connected to an eye cup or an 18 gauge plastic catheter. The eye cup helps to avoid any splashes from the cleaning process. The syringe is then filled with a cleaning solution determined by the doctor.
When the doctor uses both hands to push the barrel of the syringe, it creates a pressure of 25 to 40 PSI. PSI means Pounds per Square Inch, which is simply a way of measuring pressure. Note that it can be harmful to tissues if the pressure exceeds 70 PSI.
Studies suggest we should use around 50mL of cleaning solution for every centimeter of the wound length. This is the same as using 250mL of cleaning solution for every 5cm of wound length.
Once the doctor feels confident that the wound is thoroughly cleaned and no foreign material remains, they can then proceed with either dressing the wound or suturing it, depending on the situation.
Possible Complications of Wound Irrigation
If a wound is still actively bleeding, it should not be cleaned with a liquid (irrigated), because this might stop blood clots from forming. If a wound is not properly irrigated, leftover materials or pus might remain in it, especially in cases of abscesses, which could potentially lead to the creation of a new passage, or sinus, in the body. If you’re using a type of antiseptic called povidone-iodine, you need to be careful not to pour too much of it directly into the wound. Instead, it should be applied around the edges of the wound.
What Else Should I Know About Wound Irrigation?
Proper care for a wound includes a process called wound irrigation. This essentially means cleaning out the wound, which can lead to improved healing, a lower chance of getting an infection, and reduced likelihood of having to be admitted to the hospital. So, if you have a wound, it’s important to keep it clean, not just for comfort, but to encourage faster healing and to prevent any complications.
