wound care

[APACHE3]

Ok, I'm back again.. When I'm suturing up a patient, do I IRRIGATE wound first, then soap, then lidocaine, then sterile drapes? Whats the order? And..what do you suggest as an irrigating agent..NS or 1/2 NS 1/2 betadine, etc... Thanks

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[ERMudPhud]

Ok, I'm back again.. When I'm suturing up a patient, do I IRRIGATE wound first, then soap, then lidocaine, then sterile drapes? Whats the order? And..what do you suggest as an irrigating agent..NS or 1/2 NS 1/2 betadine, etc... Thanks

Lidocaine, irrigate, drape, suture. Irrigate with anything you want short of sewage. Studies have shown the key is volume not the sterility of type of irrigation solution. You can probably get the best results irrigating with high flow tap water but lots of places still don't accept that. Also make sure there is no debris or dead tissue left in the wound-very important. Betadine and soap are toxic to tissues and can slow wound healing so pouring them into the wound is probably a bad idea. You will see some old school plastics guys still doing it though.

 

[APACHE3]

I have the Scutmonkey book, but it did not elaborate on the order of suturing the wound.so thanks. And I only irrigated with NS, but I did scrub the area around it with a betadine brush. I'll try hibiclense (sp?)next time.

 

[spyderdoc]

I usually irrigate with running tap water when possible. Then I clean w/ betadyne and NS.

If I can't get the wound under a running tap, I like to pour some betadyne into a bottle of NS, then poke a few holes in the cap with an 18g needle, then squeeze away! Good flow, easy to aim, and just toss it out when done.

I always get that puzzled look from the techs when they ask what size gloves I want, and I reply "mediums". I rarely use sterile gloves for routine simple laceration repairs (evidence based of course...).

 

[Jeff698]

Occasionally I'll do a brief cleaning job to get rid of the large debris, then use lidocaine/bupivicain/etc before the serious irrigation if it looks like it'll be painful.

I like the little gun thingees that plug into a liter of NS and can squirt the NS into the wound under pressure. I find I can generate higer pressures with it than the bottle with 18g holes poked into it (my second best approach).

I'll use sterile gloves on occasion. Namely, those occasions where we have the crappy exam gloves in the room that tear apart easily and fit like crap.

Take care,
Jeff

 

[TysonCook]

There are several good articles and a book by Dr. Trott from Cincy w/a lot of info on it. I'll try to find a couple in a few days and post the refs for these but according to my attendings at Cincy as well as here at Carolinas...
-It's the pulsitile action of your washing, not the the steady stream that makes a difference, but flushing is the most important thing to do.
-Betadine is cytotoxic and causes increased damage, prep around the wound w/it, and it is only effective if you let it dry. in studies of betadine w/NS, and just NS, there was no difference in infection rates.
-25cc-40cc/cm with a syringe w/splash guard, a "hole in NS IV bag" has been published w/a higher infection rate than standard syringe flushing (need for specific PSI acheived study).
-Sterile gloves are not necessary, no evidence for.

There are several others, the wound book by Trott published in 2005 is excellent, give it a look. I will try to find a few good articles in the next few days as I'm getting a little beat.

 

[Jeff698]

Perhaps you misunderstood what I meant. The gun thingee attaches to the administration set port of an IV bag, just like the IV tubing. The gun thingee is a suction pump that pulls the saline (water would work as well but it doesn't come in just handy packages) down, under pressure, and through the end of the gun thingee. It is a manual pump so each squeeze pulls a little more.

BTW, gun thingee is an acceptable medical term.

Take care,
Jeff

 

[totalbodypain]

I heard somewhere you can pee on a wound to clean it out and that would......Uh nevermind thats jellyfish stings.