1SCHHS, Sunshine Coast, Australia
It is commonplace to have patients present to the emergency department with contaminated wounds requiring primary closure. As nurses in the ED we need to give the patient and their wound the best chance possible to heal. Decontaminating the wound through means of irrigation is important for two reasons: 1. debridement of contaminants and 2. dilution of microbial load. For effective wound irrigation, there is a need for 8-15 PSI. There is also a need for 100mls of fluid per cm of wound. There is good evidence to demonstrate effective pressures can be generated by using a syringe and 18g needle. This creates an increased workload that requires the clinician to continually draw up fluid into a syringe. When a wound is large it could mean the drawing up of fluid 50 times or more. This includes removing the 18g needle and attaching it again 50 times. What if there was a way to effectively provide adequate pressure while ensuring the process is simple enough to ensure adequate volume is used to decontaminate the wound. Would you say this is a revelation for both the patient and the clinician. Then you would be right!
Effective irrigation of contaminated wounds can be achieved using a hand pump IV set and an 18g needle. This has been tested by constructing a pressure manometer and attaching it to irrigation devices to determine the pressure generated.
The simplicity of using this setup for wound irrigation allows for both adequate volume of irrigation and adequate pressure to remove contaminates. When an improvement in care can be accomplished using equipment that is commonly found in the ED it has potential for improved patient outcomes at a minimal expense to the health service and the clinician.
Rob McDonald is an emergency nurse that is growing in weight, grey hair and love of nursing in the Emergency Department. He works on the beautiful Sunshine Coast and has recently been endorsed as a Emergency Nurse Practitioner. He loves his wife, children and reviewing evidence to ensure what we practice is in the best interest of the patient.