Types of Wound Irrigation Solutions and the Need for Wound Assessment

Wound Irrigation SolutionsWound irrigation refers to the steady flow of a solution over an open wound surface in order to provide wound hydration and eliminate deeper debris. It is regarded as the most consistently effective wound cleansing method compared to swabbing or bathing and is essential for quality wound care. The critical step in wound irrigation is selecting the most appropriate solution. The ideal characteristics of an irrigant are isotonic, nonhemolytic, nontoxic, transparent, easy to sterilize and inexpensive. But it is impossible to find a solution that has all these characteristics. Let’s take a look at the conventional topical irrigants used for wound care.

Normal Saline

Current literature typically supports the use of normal saline. This solution is isotonic and used because of lowest toxicity (safety is higher) and physiologic factors. However, normal saline is not as effective as other solutions to cleanse dirty, necrotic wounds.

Sterile Water

Sterile water is prepared through distillation. It is nonpyrogenic, does not contain antimicrobial or bacteriostatic agents or added buffers and is a less expensive alternative to isotonic saline. Since this solution is hypotonic and may result in hemolysis and will be readily absorbed by the tissues at the time of surgical procedures, its use is not recommended under such conditions. If excess volumes are used, it may result in water toxicity.

Potable Water

If normal saline or sterile water is not available, potable water is recommended. This solution is particularly suitable for austere environments.

Commercial Wound Cleansers

Commercial wound cleansers are now widely used for wound irrigation. The surfactant content in cleansers helps to remove bacteria and cellular debris with less force. In this way, cleansers may be a better choice for wounds with adherent cellular debris, or dirty, necrotic wounds. The preservatives contained in cleansers slow down the growth of bacteria, molds, fungi and extend product shelf life.

Povidone Iodine

This is a broad spectrum antimicrobial solution and it is effective against a variety of pathogens such as Staphylococcus aureus. Its cytoxicity to healthy cells and granulating tissues is a disadvantage. As the solution dries, it tends to cause discoloration to the skin. This solution also causes local irritation to the periwound skin.

Hydrogen Peroxide

Although 3% solution of hydrogen peroxide is a widely used wound antiseptic, few studies report its efficacy as an antiseptic. As a result, its use remains controversial. According to the American Medical Association, if hydrogen peroxide is used at full strength, its effervescing cleansing action may act as a chemical debriding agent and help remove debris and necrotic tissue from the wound surface. Also, irrigation with normal saline is recommended after full-strength hydrogen peroxide. Hydrogen peroxide is not recommended for use in wounds with sinus tracts.

Sodium Hypochlorite

Sodium hypochlorite or Dakin’s solution has been typically used to control infection in pressure ulcers with necrotic tissue. This solution is known to be effective against bacteria commonly found in open wounds. Sometimes, it is used over cancerous growths to control bacteria as well as minimize odor. However, sodium hypochlorite is found to be cytotoxic to healthy cells and granulating tissues, and not recommended to use for periods longer than 7-10 days

Wound Assessment and Documentation

Since all these irrigants have their own characteristics and are suitable for different situations, it is very important to assess the patient’s wound in great detail. Careful initial and repeat assessment will help wound care nurses and physicians to choose the most appropriate irrigant and evaluate the progress. The examination should cover the location, depth, dimensions of wound, evaluation of wound bed and surrounding skin and analysis of exudate or odor, if present. Wound care professionals should not just perform wound assessment, but also document the wound characteristics in the proper manner. Typically, the following details from wound assessment are documented:

  • Anatomic location of the wound
  • Wound dimensions
  • Wound depth
  • Location and amount of tissue destruction
  • Appearance of wound bed
  • Color, type and percentage of necrotic tissue in wound bed
  • Color, consistency, odor and amount of exudates
  • Periwound condition
  • Induration and extent of wound margin
  • Signs of infection, if any

Rather than using a general EMR, you can rely upon wound EMR to document all these details in a prompt and quick manner. Unlike general templates, wound EMR includes templates that are only related to wounds. Since this type of EMR is customized to wound care, you won’t miss any details and will be able to access the required data quickly. If supported with a physician and nurse interface, you can enhance the communication between them and ensure appropriate selection of cleansing solutions.