The Essential Role of Wound Irrigation

Proper wound hygiene gives wounds a better chance at healing. Wound irrigation is one method to promote healing, reduce the risk of infection, and maintain healthy wounds.

An estimated 12.2 million patients are seen at emergency departments (EDs) for wound closure or wound management each year, according to one study. Out of these patients, 2.47% develop an infection from a wound managed in the ED.

Wound irrigation is a form of wound cleansing and considered the most effective way to adequately cleanse a wound. This method helps to move a wound from the inflammatory phase into the proliferative phase of healing and is a way to keep wounds healthy.

What is wound irrigation?

When a wound is irrigated, a cleansing solution is streamed across its surface. The purpose is to remove surface and cellular debris, remove bacteria and necrotic tissue, and aid in visual inspection.

This treatment benefits most wound types, as it decreases the likelihood of infection and helps prevent occurrences of trauma in the wound bed.

5 irrigation methods

Bedside irrigation is typically done under low pressure using between four and 15 psi (pounds per square inch). Pressure within this range can effectively cleanse the wound and safely remove any debris, bacteria, or necrotic tissue. A pressure less than four psi is typically considered too low to be effective in removing biofilm and bacteria. Greater than 15 psi may cause harm to developing granulation tissue and further stall wound healing.

There is not a one-size-fits-all approach to wound irrigation. Various factors, including wound type and condition of the wound, can help determine the best technique for irrigation. Below are some common irrigation methods:

1. Piston syringes with no angiocath will deliver less than six psi. A piston syringe with an 18-gauge angiocath delivers approximately eight psi.
2. Pressurized saline cans deliver approximately 8 psi. These should be single patient use only. They should not be used between patients.
3. Microjets provide a highly concentrated jet of cleaning solution. The pressure is modified by how close or far the wand is held from the wound.
4. Pulsatile irrigation typically produces between eight and 10 psi. Some have adjustable flow rates and various tip shapes and sizes. Pulsatile irrigation uses a pressurized, pulsed solution over the wound bed, and some brands have suction for removing solution and debris.
5. Jet lavage gives a continuous flow of fluid at approximately eight to nine psi. The spray pattern of jet lavage is a wider, horizontal flow of solution.

Types of wound irrigation solutions

There are several irrigation solution options. Choose one that is gentle and not harmful to developing granulation tissue. This includes avoiding conventional, over-the-counter antiseptic solutions. The more common irrigation solutions include:

• Normal saline
• Sterile water
• Potable water
• Commercial surfactant cleansers
• Commercial antimicrobial cleansers

Irrigation can be performed on nearly any type of wound. Wounds associated with a fistula, near a vascular area, and/or those with an unknown depth should be thoroughly evaluated prior to irrigation. Actively bleeding wounds should have hemostasis achieved prior to irrigation.

Irrigation challenges and considerations

Pulsed, microjet, and jet lavage require specific tools and may be cost prohibitive to some facilities. Additionally, some patients may not tolerate irrigation well, no matter the psi. This is especially true with painful wounds such as calciphylaxis and pyoderma.

Since wound irrigation uses solutions under pressure, precautions should be taken to protect from splash back. Personal protective equipment (PPE) such as plastic syringe shields can be helpful at preventing splash back. Face shields, masks, gowns, and goggles should also be considered.

Research has shown that wound irrigation is an essential part of the healing process and is successful in reducing infection. Through effective use of appropriate psi irrigation, you can enhance the treatment process for your patients.

And for patients with wounds that are stalled and have otherwise been optimized (e.g., adequate vascular status, adequate nutritional status, no untreated infection), beginning irrigation can be a game changer for achieving wound healing.