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UNIT 4 Supporting Physiological Function
pain. Key Point: The most used wound irrigation solu- tion is normal saline. Bacterial growth in saline may occur as soon as 24 hours after opening the saline bottle. Sterile water may also be used for irrigation, particu- larly when other solutions are not available. Ideally, the irrigation solution should be: Isotonic to prevent injury to healing tissue. Nonhemolytic to prevent bleeding. Nontoxic to healing tissue . Cytotoxic solutions may impair wound healing. Transparent to allow visualization of the wound bed. Inexpensive for frequent irrigation using a sufficient volume of solution. Warmed to room temperature to prevent hypothermia. Selecting an Irrigation Delivery Method. The following are common methods of delivery. ■ Piston syringe for irrigation. This larger, sterile, dis- posable syringe has a thumb ring designed to mini- mize hand slippage and prevent contamination. The elongated tip is able to better direct the stream of irri- gation fluid.
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contamination from biofilm in the hospital setting and in patients with a higher risk of acquiring infec- tion (compromised immune system, other comorbid- ities). Biofilm (a coating of bacteria that adheres to a surface) forms in hospital water delivery systems. Biofilms impede wound healing by reducing the effectiveness of fibroblasts in repairing the wound bed. This substance also reduces the effectiveness of antimicrobials. ■ Liquid or foam skin cleansers that are pH balanced may be used to cleanse periwound skin or inconti- nence effluent. They are not for use inside wounds. Key Point: The most important thing to remember is to use universal precautions to minimize the risk of cross-contamination when cleansing periwound or other nonwound skin. Irrigating Wounds Nurses commonly use irrigation (lavage) to: ■ Cleanse wounds by flushing debris and bacteria on the surface. ■ Hydrate the site. ■ Remove debris for better visual inspection of the wound and periwound surface. ■ Facilitate progression from the inflammatory to the proliferative phase of healing. ■ Improve wound healing from the inside tissue layers to the skin surface. ■ Reduce infection by preventing premature surface healing, especially over an infected area of a wound. Selecting Irrigation Solution. Irrigation solu- tions include topical cleansers and antiseptics to clean wounds, antibiotics and antifungals to prevent or treat wound infection, and anesthetics and analgesics for Skin Integrity and Wound Healing ■ Scenario 1— Mary is caring for Mrs. Skylar, a 62-year-old patient with diabetes and venous stasis ulcers on her legs. Since developing these venous stasis ulcers, Mrs. Skylar has become very self-conscious and embarrassed about her legs.When taking Mrs. Skylar to x-ray, Mary covers Mrs. Skylar’s legs with a bath blanket for comfort and privacy. Mary was not only providing comfort and protecting privacy. She was also aware of Mrs. Skylar’s feelings and cared enough to respond to them. ■ Scenario 2— Mr. Robert Brown is an 18-year-old paraplegic who has developed a stage 4 sacral pressure ulcer with a foul odor. He is expecting sFome of his friends from school for a visit. Ken, his nurse, while nonchalantly cleaning up the room, makes sure to remove the garbage liner with the old dressings in it. He also brings in some fresh-cut flowers and a cup of wet coffee grounds. Both the flowers and the coffee grounds are natural odor eliminators. Mr. Brown has a great visit with his friends from school.
The use of a bulb syringe is not advised because it increases the risk of aspirating the drainage and disrupting heal- ing granulation tissue.
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■ Commercial irrigation systems, such as whirlpool agitators, whirlpool hose sprayers, pressurized can- isters, and pulsed lavages. Continuous irrigation is an uninterrupted stream of irrigation solution to the wound’s surface. Pulsed irrigation is the intermittent delivery of irrigation solution. Choosing Safe and Effective Pressure ■ To remove debris from a wound, introduce the irri- gation solution with a gentle amount of force. Ideal irrigation pressures range from 4 pounds per square inch (psi) to 15 psi. ■ To remove material adhering to the wound bed , use a 35-mL syringe attached to a 19-gauge angiocatheter to deliver the solution at approximately 8 psi (Lewis & Pay, 2022).
Pressures above 15 psi increase the risk of driving bacteria into the tissues, as well as causing mechanical damage to the wound and increasing the risk of infection (Gabriel & Schraga, 2021). Closely evaluate the amount of pressure com- mercial irrigation systems deliver before you use these devices. High-pressure irrigation systems (35 to 70 psi) may (1) dislodge healing granulation tissue and new epithelial cells, especially in chronic wounds, (2) cause pain, and (3) drive bacteria deeper into the wound compartment, leading to an increased risk of infection (Gabriel & Schraga, 2021).
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Using Appropriate Volume for Irrigation A sufficient volume of irrigation solution for flushing is necessary for proper cleansing of the wound. The ideal volume is 50 to 100 mL per centimeter of length of the laceration (Gabriel & Schraga, 2021). However, more
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