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Irrigation and debridement are methods used to clean wounds, removing dead material and flushing the wound to remove organisms and dead cells. The procedure can be used as part of an initial response to injury, cleaning the wound to determine the extent of the damage and start treatment. It may also be a follow-up treatment if a patient’s injury appears to need additional care. Some patients find irrigation and debridement uncomfortable, and may receive sedation or local anesthetics first to help them relax.
Saline is a common choice of fluid for this procedure. Soaps cannot be used because they may injure cells. A syringe or similar device can be used to gently spray fluid into the wound, starting in the middle and working out. This can flush out dirt, rocks, and other foreign bodies that may be present, along with pus, clots, and dead cells. Debridement involves carefully trimming away dead or infected tissue to leave healthy material behind.
Open injuries may need irrigation before treatment. This is important to remove organisms that might cause infection, as well as debris like glass from a car accident. While irrigating the wound, first responders can learn more about the nature of the injury and work on a treatment plan. Some debridement may be performed to remove obviously injured tissue that is unlikely to survive before proceeding with surgery, bandaging, and other treatment options.
As wounds start to heal, they can be evaluated to determine if they need irrigation and debridement. Frequent cleaning can disrupt the healing process, increasing the risk of infection and scarring. Failing to take action when dead tissue is accumulating or there are clearly foreign bodies in the wound can be equally dangerous. The wound can be accessed during bandage changes to determine whether it requires irrigation and debridement to stay clean and promote even healing.
Hospital settings are often used for irrigation and debridement, but it can be performed at home by a visiting nurse or medical technician if necessary. Debridement can be painful, as it may involve cutting into the skin or disturbing scabs. Local anesthetic may be applied to numb the site before starting to work. Patients can speak up if they feel uncomfortable, as this may be an indicator that the anesthetic is wearing off or that there’s another problem, like nerve damage in the area around the injury. Full general anesthesia may be used for cases where extensive irrigation and debridement are required, like with burn victims.
When I was training to become a paramedic, we had to go on rounds with doctors and nurses in the emergency room. We needed to know what kinds of injuries we would expect to treat in the field, especially ones caused by accidents. I think irrigation and debridement was the hardest procedure to observe. I was in a bad car wreck myself, and all I could do was feel the victim's pain as the doctors washed out the wounds and extracted glass and rocks and other debris.
It proved to be very useful training for actual code runs, since paramedics can do some irrigation and debridement on accident victims before putting them on a gurney for transportation.
When my brother crashed his motorcycle, the ambulance arrived and took him to the hospital before any of us knew what happened. When we got to the hospital, the ER nurse told us that he was in the irrigation and debridement room. He apparently skidded right down the middle of the road and got a serious case of "road rash" from the waist down.
I was allowed to visit him for a few minutes while the doctor was removing the gravel, and he was obviously in bad pain. The doctor said he would be giving him a local anesthestic as soon as the wounds were cleaned out completely. I had never seen so much blood in my life, but the doctor said it wasn't that unusual after accidents like my brother's. I think they did give my brother a blood transfusion later.
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