Page 71 - PJ MED OPS Handbook 8th Ed

Wound Care
Wound Irrigation

Indication:
Cleaning of wounds prior to applying long term dressings or primary closure.

NOTE: If a wound is bleeding heavily, controlling bleeding takes precedence.

CAUTION: DO NOT irrigate wounds with hydrogen peroxide, betadine scrub solution, isopro-
pyl alcohol, or other chemicals. The ‘Rule of Thumb’ is to only put on a wound what can be
placed on the eye.
Procedure:
1. Provide analgesia and anesthetize the wound, if required. Lidocaine jelly can be used topically,
but is much less effective than intradermal lidocaine.
2. Remove gross debris manually with fingers, forceps or clamps.
3. Using low pressure irrigation technique, irrigate the wound with NS, LR or other isotonic sterile
solution. If NS or LR is not available for wound irrigation, potable water may be used for wound
irrigation.
4. Irrigation can be accomplished by fitting an 18 gauge angiocath to a 30–60cc syringe and squirt-
ing the wound using LIGHT pressure on the plunger of the syringe. DO NOT ‘inject’ the tissue of
the wound with the catheter: The catheter tip should be held about ½–1" from the wound. Dry
the wound and wound area prior to bandaging.
a. Another option is to use a plastic/Ziploc bag with water, create a pinhole and press the bag
and irrigate from the hole. Can use IV tubing, camelback hose, etc. Running the wound under
a potable water faucet or pouring water from a water bottle slowly are additional options.
b. Alternatively, damp sterile dressings may be used to blot the wound area. Do not vigorously
scrub internal tissue.
5. Very dirty wounds can be irrigated with an antimicrobial wound wash or a solution of 1% Beta-
dine in NS (add 1mL of 10% betadine solution for every 9mL of NS), then given a final ‘rinse’ with
plain NS.
6. Abrasions (such as ‘road rash’) may have to be scrubbed to remove dirt and imbedded debris.
7. Wounds should be irrigated with a minimum of 100mL or until the wound is clean. Grossly con-
taminated wounds (such as an open fracture with dirt ground into the broken bones) may re-
quire physical debridement along with irrigation.
8. Use universal precautions when irrigating a wound. Proper wound irrigation technique will
splash irrigating solution everywhere.

Chapter 6. Surgical and Medical Procedures n 69