Indian Journal of Plastic Surgery
An open access publication of Association of Plastic Surgeons of India
Users Online: 1971  
Home | Subscribe | Feedback | Login 
  Navigate here 
  Search
 
  
 Resource links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (613 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed6482    
    Printed42    
    Emailed1    
    PDF Downloaded106    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 45  |  Issue : 3  |  Page : 590-591
 

Syringe-based wound irrigating device


Department of Plastic and Reconstructive Surgery, Christian Medical College, Vellore, India

Date of Web Publication12-Jan-2013

Correspondence Address:
Rahul Shetty
Sr PG Registrar, Department of plastic and reconstructive surgery, Christian Medical College, Vellore, TN
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0358.105996

Rights and Permissions



How to cite this article:
Shetty R, Paul M K, Barreto E, Sreekar H, Dawre S. Syringe-based wound irrigating device. Indian J Plast Surg 2012;45:590-1

How to cite this URL:
Shetty R, Paul M K, Barreto E, Sreekar H, Dawre S. Syringe-based wound irrigating device. Indian J Plast Surg [serial online] 2012 [cited 2019 Jun 19];45:590-1. Available from: http://www.ijps.org/text.asp?2012/45/3/590/105996


Sir,

Wound irrigation is an important aspect of wound treatment, which helps decrease bacterial contamination. The hydraulic forces generated by the stream of fluid acts on the debris on the wound surface and flush it from the wound. In order to remove the wound debris, the force of the irrigation stream has to be greater than the adhesion forces holding the debris to the wound surface. In 1994, Agency for Health Care Policy and Research (AHCPR) recommended a pressure of 10-15 pound per square inch (psi) to be ideal for wound irrigation. [1] Compared to swabbing or bathing, wound irrigation is considered to be most effective in wound cleansing. [2]

Many techniques of wound irrigation are currently in use. [3] Some of these, such as bulb syringe irrigation, deliver low pressure and may not be effective in decreasing bacterial load. [4] High-pressure, pulsatile irrigation devices are expensive, cumbersome, and difficult to keep sterile. A more practical and convenient way to produce pressurized irrigation is to deliver the irrigant from a syringe through a needle or catheter. It has been shown that delivery of saline from a 35-ml syringe through a 19-gauge syringe delivers a stream of irrigant to the wound surface at 8 psi. [5]

Experimentally, we have assessed the pressure generated by combinations of syringes and catheter sizes. In general, as the size of the syringe increases, the pressure decreases because the force applied to the plunger is distributed over a larger cross-sectional area. In contrast, increasing the size of the needle increases the pressure, as there is greater flow. We found that a 20-ml syringe attached to an 18-gauge angiocatheter delivers a stream of irrigant to the surface at approximately 12 psi [Figure 1].
Figure 1: Experimental assessment of pressure generated

Click here to view


Using this knowledge, a simple device was constructed from materials easily found in the ward. A 20-ml syringe was connected to a plastic tubing of an 18-gauge angiocatheter needle through a "three-way" connector. One inlet of the "three-way" connector was connected to a bag of normal saline on an intravenous (IV) stand. An empty IV fluid plastic bottle was cut by around 10 cm from the tip. The cut was made at an angle of 45°. The tip was then plugged on to the syringe. This funnel-shaped IV bottle piece formed a shield and prevented splash back [Figure 2]. This was important in view of significant risk of contamination with such fluids. It also made the whole process less messy. The oblique cut was made to facilitate a tangential administration of the irrigant. This also helps in easy outflow of the lavage fluid elute through one side from where it was collected into a sterile basin. The patient was positioned such that the lavage elute flow was from the upper end of the wound downward. The fluid (normal saline) was withdrawn into the syringe and the plunger was then depressed to spray the wound with the irrigant. Because of the "three way" connection fluid was sucked into the syringe on withdrawing the plunger. The total volume of irrigant used depended on the size of the wound.
Figure 2: Wound irrigation

Click here to view


This could make irrigation of wounds more convenient. One drawback of this method is operator fatigue while irrigating large wounds, and it may be better suited for medium- to small-sized wounds.

 
  References Top

1.Bergstorm N, Bennett MA, Carlson CE, Allman MR, Alvarez M, Oscar Bennet MA.Treatment of pressure ulcers: Clinical practice Guideline No. 15. Rockville, MD: US Department of health and human Services, Public health Service, Agency for Health Care Policy and Research; 1994. p. 6-7,47-53. AHCPR Publication No 95-0652.  Back to cited text no. 1
    
2.Ennis WJ, Valdes W, Salzman S, Fishman D, Meneses P. Trauma and wound care. In: Morison, MJ, Ovington LG, Wilkie K, editors. Chronic Wound Care. A Problem-Based Learning Approach. Chapter 17. London: Mosby Elsevier Limited; 2004. p. 291-307.  Back to cited text no. 2
    
3.Chatterjee JS. A critical review of irrigation techniques in acute wounds. Int Wound J 2005;2:258-65.  Back to cited text no. 3
[PUBMED]    
4.Brown LL, Shelton HT, Bornside GH, Cohn IJr. Evaluation of wound irrigation by pulsatile jet and conventional methods. Ann Surg 1978;187:170-3.  Back to cited text no. 4
    
5.Stevenson TR,Thacker JG,Rodeheaver GT, Bacchetta C, Edgerton MT, Edlich RF. Cleansing the traumatic wound by high pressure syringe irrigation. JACEP 1976;5:17-21.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 

    

Site Map  |  Home  |  Contact Us  |  Feedback  |  Copyright and Disclaimer
Online since 11th March '04
Published by Wolters Kluwer - Medknow