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CHAPTER 32 Skin Integrity & Wound Healing
5. Set up a sterile field on a clean, dry surface. Add the following sup- plies to the field depending on the type of solution and equipment to be used for irrigation:
bacteria and cellular debris with less force and slow growth of bacteria, molds, and fungi. However, some antiseptic solutions can be harmful to healing tissues (e.g., hydrogen peroxide, acetic acid, povidone- iodine, bleach solutions, and sodium hypochlorite solutions [Dakin’s solution]). 7.Pour the tepid (room- temperature) irrigation solution into the sterile bowl. Local cooling of wound tissues impairs healing.This can occur if you irrigate with refrigerated solutions and change dress- ings frequently. 8. Don sterile gloves. Gloving maintains sterile technique. 9.Place the sterile basin at the bottom of the wound to collect irrigation runoff. 10. Fill the irrigation syringe. If Using an Angiocatheter a.Attach the 19-gauge angiocath- eter (with needle removed) to the 35-mL syringe and fill with the irrigation solution. b. Fill a piston-tip syringe with irri- gation solution. 11. Gently irrigate the wound. Hold the angiocatheter tip or syringe tip 2 to 5 cm from the wound bed and use a back-and-forth motion, mov- ing from the cleanest to most con- taminated part of the wound. Irrigating from clean to dirty prevents flow of contaminated solution over cleansed area. Irrigating a clean, nonin- fected wound with gentle low pressure (8 psi) reduces disruption of the healthy, healing tissue. Irrigating an infected wound with higher flow (but <15 psi) selectively debrides necrotic tissue while protecting healthy tissue. Consult the provider. ➤ A 19-gauge angiocatheter (with needle removed) and 35-mL syringe provide 8 psi of pressure and are effective for removing bacteria, necrotic tissue, exudate, and/or met- abolic wastes. If Using a Piston-Tip Syringe
Sterile gauze Sterile bowl Dressing supplies
A sterile commercial irrigation kit, or a 19-gauge angiocatheter, 35-mL syringe, and sterile emesis basin Setting up a sterile field at bedside pro- vides easy access to equipment for irriga- tion and reduces the risk for contamination when retrieving supplies after getting started.
a. Ensure any undermining or tun- neling is irrigated as well. b.Repeat the irrigation until the solution returns clear. Flushing removes exudate, debris, and some surface bacteria. 12. Remove the basin or sterile con- tainer from the base of the wound. 13. Gently pat the skin surround- ing the wound dry with sterile gauze. Moisture on the surrounding tissue may lead to maceration and further break- down of the wound margins. 14. Dress the wound as prescribed. 15.Consider applying a water- proof skin protectant around the wound if drainage is heavy. Wound drainage contains irritating chemicals that can damage healthy tis- sues, especially at the wound edge and surrounding skin. Solutions used to keep the wound bed moist can also macerate or damage healthy skin if allowed to remain on intact skin. 16.Dispose of the contaminated irrigation fluid in a biohazard receptacle. Contaminated fluid is biohazardous waste. 17. Remove soiled drapes from the patient area.
6. Select irrigation solution based on the wound assessment and goals of therapy. Sterile saline or sterile water is the solution of choice for irrigation of most wounds. Although cleansers are commonly prescribed for irrigation of wounds with debris or in dirty, necrotic wounds, tap water has now been shown to yield the same results as sterile saline in both wound infection rate and wound healing (Chan et al., 2016). Do not use povidone-iodine (Betadine) if the patient has an iodine allergy. Normal saline is isotonic and the com- monly used wound irrigation solution because it is not damaging to healing granulation tissue. It is also isotonic (sim- ilar to the body’s natural lowest salt-to- water balance). Sterile water contains no antimicrobial or bacteriostatic agents or added buffers. Cleansers contain surfac- tant (soaplike substance) that removes
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