By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Wound irrigation, when performed properly, can enhance wound healing. It is not as simple as pouring normal saline over a wound prior to dressing it – it must be performed properly in order to get the most out of this frequently misunderstood intervention.

What is wound irrigation?

Wound irrigation involves the use of fluid to remove:

• cellular debris that is loosely clinging to the wound
• surface bacteria
• wound exudate
• dressing residue
• residual topical agents

The purpose of wound irrigation is to assist with the maintenance of a moist wound environment, facilitate debridement and boost wound healing.

What types of wounds can be irrigated?

All wounds can (and should) be irrigated. Gentle irrigation is the treatment of choice for healing granular wounds, along with bandaging to protect the wound bed.

Are there any wounds that shouldn't be irrigated?

Irrigation should not be performed in wounds that are actively bleeding heavily, as irrigation may dislodge any clots that are forming.

How is wound irrigation performed?

The following are some points to keep in mind regarding wound irrigation:

• Wounds should be irrigated every time you change the dressing. Wounds should also be irrigated upon initial assessment, as this will allow you to more fully and accurately assess the wound.
• Normal saline is the most frequently used irrigant; however, there is evidence that tap water may result in faster wound healing, provided a clean water source is available, and tap water is also far more cost effective.
• Pressure is the key to effective irrigation. Too little pressure will fail to remove surface bacteria, which may lead to wound infection. Too much pressure can actually force surface bacteria into the wound bed, in addition to damaging delicate granulation tissue. Irrigation pressure should be between 4 and 15 psi. Pressurized saline canisters also provide an acceptable alternative. Higher pressures (i.e. 10 to 15 psi) will be more effective at preventing infection, according to recent research.
• Wound irrigation may be performed alone or in conjunction with other modalities, such as whirlpool. Studies have shown that irrigating wounds following whirlpool treatment removes four times as much bacteria.

To perform wound irrigation:

1. Explain the procedure to the patient.
2. Position the patient to provide access to the wound.
3. Remove the old dressing.
4. Drape the patient appropriately for modesty and pad around the wound with towels or padding to absorb the irrigant solution.
5. Don protective equipment (eye protection, gloves, and gown and mask).
6. Irrigate the wound using the appropriate pressure.
7. Pat dry any intact skin and cover open areas with sterile gauze or a sterile towel.
8. Redress the wound after performing any necessary measures such as debridement.

You should be careful to allow the solution to flow from the cleanest to the dirtiest area of the wound. Do not force irrigant solution into any wound pockets i.e. areas of tunneling.

What are the advantages of wound irrigation?

Wound irrigation is easy to perform, quick, inexpensive and effective. Wound irrigation can be performed almost anywhere (any setting) on any part of the body. Patients may be taught to perform wound irrigation at home.

What are the disadvantages of wound irrigation?

Wound irrigation is messy. Linens and clothing may be soiled if care is not taken to protect them. Concern regarding soiling of clothing or furniture may lead to use of insufficient amounts of irrigant.

Wound irrigation is a common task performed by wound care clinicians. It is done prior to dressing changes and can facilitate healing and prevent infection.

Sources:
Meyers B. Wound Management: Principles and Practice. 2nd edition. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008.
Owens B, White D, Wenke J. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. Journal of Bone and Joint Surgery. 2009;91(1):92-98.

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.