Wound Irrigation: An Overview, Tips and Techniques

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Open wounds are a portal for infections. Proper wound care is necessary to prevent infection and promote healthy healing of the skin. The best way to speed up the healing process is through wound cleaning and irrigation. Cleaning and wound irrigation is the first step in caring for a wound. Wound irrigation is the single greatest intervention in wound care that will reduce the risk of infection. Continue reading to learn more about the process of wound irrigation.

What is wound irrigation?

Wound irrigation is the process of flushing a wound with a gentle stream of a specific liquid to remove dead and necrotic tissues. This helps reduce the bacterial load from the wound and maintain a moist wound environment. The choice of irrigation solution depends on the severity of the wound. The process helps remove slug, extracellular debris, bacterial contaminants, and dressing residues without impacting the cellular activity vital to the wound healing process.

When to irrigate a wound?

Wound irrigation manages both acute and chronic types of wounds. All wounds can be irrigated except those that are actively bleeding. Irrigation, in this case, may dislodge any blood clots.

In acute wounds, irrigate the area for a thorough examination and determine the severity of the wound. In chronic wounds like ulcers, wound irrigation removes the dead tissues and accumulated debris that can help reduce bioburden and aid the healing process.

Irrigate the wound when you change a bandage or wound dressing to help moisturize the area and promote healing.

In most cases, wound irrigation is easy and non-invasive. But if the wound causes severe pain, it is advised to do it professionally under local anaesthesia with a doctor’s recommendation.

How to clean a wound?

Wound irrigation is a systematic process that needs to be done with extra care. One has to follow a holistic approach in wound care, following the recommended procedure and using the appropriate cleaning agent based on the nature of the wound and the condition of the patient. If you have a serious injury, your doctor will recommend the right procedure and the specific cleaning agent required for cleaning.

Solutions for cleaning a wound

There are a couple of different solutions to irrigate a wound.

Wound irrigation should be done with a fluid with similar osmotic pressure to that found in living cells. The wound cleansing solution must be known to be non-toxic to human tissues and remain effective in the presence of organic material to reduce the number of microorganisms. It should not cause sensitivity reactions and should be widely available and cost-effective.

Material Required for Wound Cleaning:

  • Regular Saline: Regular Saline is the most common cleaning solution for wound irrigation. It is safe to use and readily available in drug stores. It is universally considered the irrigation fluid of choice.

  • Sterile water: Sterile water for wound irrigation contains normal water that is sterilized and packaged as an irrigant. It is non-toxic to tissues but is hypotonic and may cause swelling of the cells.

  • Hydrogen Peroxide: Hydrogen peroxide is a commonly used cleaning agent. It is a highly reactive oxidizing agent effective against a broad range of organisms. But this may cause irritation to the tissue.

  • Potable water: It is safe and effective as sterile water. It is used in an environment where sterile water or saline is unavailable. If the wound is not contaminated, potable water is a good alternative.

  • Povidone-Iodine: In case of deep wounds infected with known microorganisms, the use of Povidone-Iodine is a good option. Extreme care should be taken while using this solution, as this can damage healthy cells.

  • Sodium Hypochlorite:  This cleaning solution is used for necrotic wounds and ulcers. It is an excellent antimicrobial agent.

Steps to Irrigating a Wound

After choosing the best cleaning solution to irrigate your wound, there are a few more steps in the wound irrigation process. 

All necessary supplies should be gathered to prepare the wound area, irrigate it, and the area should be packed with the prescribed dressing as indicated in the wound care plan.

Gather the Necessary Supplies

Some of the necessary supplies are an antiseptic solution to clean your hands, gloves, cleaning solution, sterile water, protective linen, emesis basin, a syringe filled with prepared solution, catheter, Sterile probe, and wound measurement guide.

Preparing the Wound

Assess the pain, size, and exudate of the wound. 

Collect all the necessary materials and irrigation solutions. Allow the solution to reach room temperature. Place protective linen in the working area along with an emesis basin under the patient’s wound to collect the solution during the wound irrigation process. The patient should be positioned to allow proper drainage flow to the basin. Wash your hands and put on your gloves. Discard the old dressing.

The Irrigation Process

The irrigation process depends on the wound and the cleaning agent you are using. The syringe is filled with the prepared solution and connected to the catheter. Slowly and gently pump the solution in a steady uninterrupted flow into the wound area. The solution should move from clean to dirty wound areas to prevent contamination. The process should be repeated until the dead tissues and debris are removed, and the solution turns clear. Start at the edges of the wound and move towards the center if the wound is large. Dispose of the solution, drainage, and used equipment into appropriate disposal bags.

Applying New Dressings

After the wounds are cleaned with the solution, they should be covered or packed with the prescribed dressings indicated in the wound care plan. The wound should be covered with the proper size bandage. Any changes in the status of the wound or untoward changes in the vital sign should be immediately reported to the provider.

What are the advantages and disadvantages of wound irrigation?

Advantages:
  • Wound irrigation helps to remove loose necrotic materials from the wound bed and reduces the bacterial load.
  • Assist debridement and optimize wound environment.
  • Supports the healing process and helps minimize the scar.
  • Aids the wound healing from inside out towards the skin surface.
  • The process is simple and does not take much time to perform.
Disadvantages:
  • The basic disadvantage of the wound irrigation process is that it is a bit of a messy process. Extra precautions should be taken in positioning the patient and drainage collection.
  • Skillful process. One should follow the exact cleaning procedure to avoid complications.
  • Unnecessary cleaning can traumatize fragile new tissues in and around the wound bed. Sometimes wound exudates may contain growth factors that help to promote wound healing. So one should be very careful while doing the procedure.

Conclusion

Wound irrigation will help flush cellular debris and drainage from the open wound. Although the type of open wound management should be individualized for each wound, wound cleansing and irrigation positively impact wound healing outcomes.

FAQs

  1. What is an irrigation solution?
    The solution used in wound irrigation flushes the debris and helps clean the wound. It helps to remove the necrotic tissue and non-viable external contamination to a certain extent. Examples of irrigation solutions include: Regular saline, sterile water, potable water, saline solution, hydrogen peroxide.
  2. What is the purpose of wound dressing? 
    • To provide a protective barrier
    • Act as a clean cover and protect the wound from the external environment
    • To absorbs wound drainage
    • To provide moisture required
    • To optimize the re-epithelialization
    • Helps to reduce the pain and aids wound healing
  3. What is the purpose of wet to dry dressing?
    Wet to dry dressing is a saline moistened dressing placed in the wound bed. It is left to dry and removed every 4-6 hours. This helps remove necrotic tissue and drainage when the wound is in the inflammatory phase. They also help to clean the wound and remove dead tissues.
  4. What does normal saline do to wounds?
    Normal saline solution (0.9% sodium chloride) has isotonicity and non-cytotoxic properties. So they are non-irritating to the skin and create a condition that makes the bacteria difficult to grow and helps prevent wound infection. Gradually this aids wound healing.
  5. What is the difference between IV saline and irrigation saline?
    Both solutions are sterile, and the chemical composition is the same. But there is a difference in their manufacturing process.IV saline is indicated for parenteral replenishment of fluid and sodium chloride. Irrigation saline is used as an irrigation solution to wash out and clean a wound. It is strictly for wound irrigation and cell cleaning.

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