Wound Cleansing and Irrigation Traumatic Wounds

  The physician or advanced practice nurse maintain hemostasis by

   1.  direct pressure and clamps and ligates vessels, if necessary. Apply a pneumatic tourniquet or a blood pressure cuff, if prescribed, to help control bleeding during wound cleansing and repair.
   2. If hair removal is necessary, clip the hair close to the wound edge or smooth hair out of the way with lubricant or antibiotic ointment. Shaving is seldom indicated. Shaving causes many small wounds and skin nicks and increases the chance of infection. Never shave eyebrows because realignment is difficult to achieve without the landmark hair, and complete hair regrowth may not occur.
   3. Begin wound cleansing using sponges or brushes and a cleansing agent. Considerations for various wound cleansing agents are as follows:

    * Povidone-iodine solutions provide good antimicrobial activity and effectively kill gram-positive and gram-negative rods, fungi, and viruses with little toxicity or damage.
    * Iodine compounds are less irritating to tissue than is tincture of iodine but may still cause cellular damage and allergic reactions.
    * Nontoxic agents such as Pluronic F-68 (Shur-Clens®) are not harmful to open wounds and eyes. Although they have no antimicrobial activity, they appear to be safe and effective and cause minimal cellular damage.
    * Baby shampoo provides gentle cleaning of fragile tissue but is nonsterile and is not antimicrobial. It is used for facial lacerations in some institutions.

   1. The preparation should begin at the wound site and should move distally, encompassing a large area of skin surrounding the wound. For example, with hand lacerations, clean the hand and arm to the elbow. Continue until the wound is clean, but do not soak the skin.
   2. Irrigate wounds that are contaminated and those containing foreign bodies. Irrigation is particularly important for bite wounds. Use a 16-gauge or 18-gauge needle or plastic cannula and a 35-ml syringe for high-pressure irrigation. Other options include a needle attached to a pressurized intravenous bag or tubing or a commercially available irrigation setup. Normal saline solution is most commonly used. Low-pressure irrigation (e.g., bulb syringe) is not effective.
   3. The following formula for determining volume of irrigant has been associated with less than 0.01% wound infection:

    * 100 ml/inch of length of laceration/hours since injury
    * Thus, a 3-inch laceration that was 6 hours old would be irrigated with 1800 ml:
    * (100 × 3 × 6 = 1800 ml).

   1. Abrasions with embedded foreign bodies (except glass) require careful wound preparation to remove the foreign bodies and prevent traumatic tattooing. Use surgical scrub brushes, sterile toothbrushes, and the point of a No. 11 blade for foreign body removal. Do not perform excessive scrubbing of tissue.
   2. Wounds with glass embedded require special evaluation and management; radiographic imaging may be necessary. Wound debridement may be necessary after anesthesia is completed.
   3. Use petroleum jelly, antibiotic ointment, or mineral oil to facilitate tar removal. After application, allow tar to dissolve for 10 to 15 minutes before attempting removal. Repeat applications may be necessary.
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