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Wound irrigation is a procedure that healthcare workers use to remove debris from wounds and to hydrate damaged tissue. In most cases, irrigation occurs when a constant supply of cleansing solution flows across or into an open wound, but swabbing a minor injury with water or an antiseptic might also be called wound irrigation. Healthcare professionals typically irrigate most types of tissue wounds, with extra emphasis on the cleansing of deep lacerations or punctures, severe burns and injuries that might result in infection. Depending on the type and severity of the injury, there are several techniques and solutions that can be used during a clinical irrigation.
Selecting the proper cleansing agent is important in effective wound irrigation procedures. Medical literature suggests that acceptable solutions are those that are non-toxic, transparent, easy to sterilize and inexpensive. To comply with these suggestions, healthcare professionals typically opt for simple saline solutions or sterilized water. For situations in which no sterile solutions are available, caregivers might use clean potable water as a replacement. In some clinical settings, medical staff members might also use commercial antimicrobial cleansers that contain povidone-iodine or hydrogen peroxide to remove certain types of bacteria and combat pathogens such as Staphylococcus aureus.
Many delivery systems are available for wound irrigation, although medical doctors and nurses often use simple items such as bulb-and-piston syringes or hanging saline bags that have attached tubes. Other commonly used delivery techniques include whirlpool agitators and nozzles, pressure canisters and pulsed lavage devices. For wounds that require continuous irrigation, any device that delivers a constant and consistent stream of solution will work, but some severe injuries might respond best to intermittent pulses of the cleansing agent. In these cases, physicians usually turn to a pressure canister or, more often, pulsed lavage irrigation techniques.
Like choosing the right solution, attaining the correct fluid pressure is an important factor in effective wound irrigation. This pressure is measured in pounds per square inch (PSI) or kilogram-force per square centimeter (kgf/cm2). High-pressure treatments of 35-70 PSI (2.46-4.92 kgf/cm2) is useful for removing necrotic tissue and dirt or debris particles from acute wounds, but most physicians prefer to use a lower pressure of 1-15 PSI (0.07-1.23 kgf/cm2).
With higher pressure comes a greater risk of infection caused by the fluid stream pushing bacteria deeper into the wound. High pressure can also cause further damage to the patient's injured tissue and might even damage bones in close proximity to the injury. The risk of splash back, which might spread bacteria to nearby surfaces or people, increases anytime a high pressure delivery method is used to irrigate wounds.
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