Archive October 2018 XIX, No. 10

Wound Irrigation in 4 Easy Steps

This 5-minute technique can help prevent a surgical site infection.

Gary Biesecker

Gary Biesecker, MD, FACS

BIO

One-Two Punch
University of Massachusetts Medical School
One-Two Punch Vigorously massaging wound margins while you irrigate with voluminous amounts of saline ensures no loose fat tissue is leftover.

You’d never forget to administer timely and appropriate prophylactic antibiotics. After all, that step is an absolutely invaluable way to prevent surgical site infections. For whatever reason, however, wound irrigation is rarely thought of with the same importance (see “Our Bundled Closing Protocol for Colon Resections” on page 48). But it certainly should. You should view the often-overlooked step of irrigation as the final piece of the patient care puzzle. To help make it part of your protocol, here are 4 simple steps you can use to effectively irrigate wounds in 5 minutes or less. You can use this simple but effective irrigation technique for everything from breast mastectomies to hernia repairs to open abdominal procedures to colon resections:

1. Begin the irrigation after closing the fascia. The goal is to focus on the subcutaneous layer and remove any loose fat or possibly contaminated peritoneal fluid that comes through.

2. Elevate and irrigate downstream. During the procedure, you want to make sure the head of the operating table is elevated, and that you have a basin by the wound. This step ensures there is little to no runoff during the irrigation process. If you just irrigate without the head of the bed elevated, it’s going to run over both sides of the bed and create a mess — as well as a slip hazard. But by raising the head up and irrigating downstream, you’ll collect almost all of the saline in that basin.

3. Combine irrigation with massage. You’ll want to use voluminous amounts of saline when you irrigate. Normally about 2 to 5 liters, but that’s just a general guide. You could wind up using a little more, you could wind up using a little less. During the irrigation process, you’ll want to vigorously massage all the wound margins, too.

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