Wound Irrigation: Procedure and Special Considerations (Nursing)

00:04 Now before the irrigation step, here's the key time to assess the wound.

00:09 If indicated, we can measure and document this appropriately.

00:13 Now before we start, let's go ahead and put on our gloves and prepare our irrigant fluid.

00:18 We want to take the irrigant and this could be whatever is prescribed by the doctor.

00:22 Typically, it's going to be normal saline that sterile, we're going to pour this into our irrigation container.

00:28 Now we're going to take our catheter tip syringe to withdraw the irrigation fluid from the container.

00:35 We're going to take that syringe and irrigate our wound.

00:38 Now if you take a look at this image here, notice that the tip of that catheter syringe or the tip of this syringe is not touching the wound.

00:47 That's important.

00:48 Also, I just want you to keep in mind when we irrigate the wound, you want to go from the clean areas, which is typically going to be the wound bed itself to the dirty areas until all the areas are cleansed.

01:01 Also just know when you're using this syringe, be gentle not a lot of force with the catheter syringe or on the plunger.

01:09 Be gentle when you're irrigating here.

01:12 And while we're irrigating, we're going to allow all of that fluid to be caught into the basin that's below the wound.

01:20 Now, you may need to repeat this step a couple of times if indicated, then we can discard the syringe.

01:26 Now also just know around the site because there's a lot of irrigant fluid, it could be moist, we can take our sterile gauze and dry the patient's intact skin and the skin around the wound.

01:38 If indicated, we may want to put skin protected if ordered, and apply the wound dressing as ordered by the physician.

01:50 Okay, so now that I performed my hand hygiene, this is a great time to assess the wound.

01:56 So a couple of things to know is we want to look at the wound bed, we want to look at the edge, we also want to take a look at the the skin around the wound, that's also important.

02:08 The other thing to know is that at this point, depending on the order or if you're tracking the wound, many time we're going to measure it at this point.

02:16 So I want you to take a look here.

02:19 So because I'm going to measure, I'm going to go ahead and put on my gloves.

02:26 In many times you have cotton tip applicators that are sterile on your unit.

02:31 This is a great device to use, because it's sterile.

02:36 Also, I want you to know that there is a measuring guide on top of here, so it makes it really easy.

02:42 Now sometimes there will be a met just a separate paper tape that's disposable that your facility may have.

02:48 So you can grab that as well.

02:50 But if you can't find one, there's one here on the cotton tip applicator for you.

02:55 So we go to measure a wound.

02:57 And I'll just quickly talk about this.

03:00 We'll open this up, we're typically going to do the length and this one's pretty long, right, we're going to take this and compare it here, we're going to do the width.

03:12 And then we're going to do the depth.

03:13 When you do the depth, you're going to go to the deepest part of the wound.

03:18 Then we're going to see what's flush on top of it.

03:20 Basically I'm going to put my fingers where the basically the where opens on the skin surface here and flush to the skin surface and then compare it to my guide.

03:32 So when you're assessing the wound, you would do for measurement, you would do length, width and depth.

03:38 Once we've done with this, we would note our measurements and then document those.

03:43 Let me go ahead and get rid of this.

03:46 So once I've done that, we can go ahead and pour irrigant solution into the canister.

03:51 So I've got this really handy irrigation tray here.

03:57 I'm going to move this little bit out of the way.

04:03 So the nice thing is with this, this has got a container here for me and my catheter syringes in here to withdraw the fluid.

04:11 So I'm going to take my sterile saline, open this up.

04:18 Let me go ahead and pour this into the container now.

04:28 Okay.

04:29 So then I could just leave my syringe in here and that way it keeps it clean and it's handy for me.

04:37 Okay, so now that I've got this, I've got my irrigant fluid poured.

04:42 I'm going to take my catheter tip syringe and pull up my fluid.

04:49 And as you can see here, I have ample fluid for irrigation.

04:53 Now I'm not going to show you today, you kind of get the general gist but we'll talk through the irrigation.

04:58 So when I'm irrigating, I'm going to go the cleanest area to the dirty.

05:02 So typically, that's going to mean I'm going to irrigate with a wound bed, then we're going to go around.

05:08 Now here's a tip when you irrigate is, when I'm pushing down on the plunger, the faster I push down, the more force that's going to go into that wound, and that can be really uncomfortable.

05:19 So a good tip is just to gently push down and see how the patient tolerates that.

05:25 And again, you may have to repeat this as necessary.

05:28 So again, using the syringe, you're going to go the clean areas to the dirty areas until all of those are addressed.

05:34 So if I was using a basin, all of that would fall under a basin -, and again, you may need to irrigate a few times.

05:42 So once I've done this, I can discard my syringe, then I'm going to take my sterile saline, or excuse me, my sterile gauze.

05:51 And because my wound got a little bit wet, we're going to take our gauze and we're going to pat dry the skin.

05:58 What I don't want to do is scrub because that could mess up the integrity of the wound.

06:07 So I can take one, discard and then just use as many as needed.

06:21 Now once I've dried all of this, sometimes there may be a physician order for certain skin protectant that needs to go around the skin of the whim.

06:29 So just keep that in mind.

06:31 Now once I've done irrigating, this is just me, it's just a great idea.

06:35 Since I've been kind of irrigating and my gloves can get wet, I'm going to go ahead and change those now and perform hand hygiene and put on some new ones.

06:45 I like to do this because I'm touching clean supplies now.

07:11 Okay, so I mean, I take my dressing.

07:15 You're going to open this up.

07:17 And I'm using an ABD pad.

07:20 So when I open this up, be conscious not to touch the inside of the dressing and I'm going to put this flat.

07:29 So good thing here is once it's covered, we're pretty safe.

07:33 So sometimes it's hard to handle tape, or things like that or the dressing.

07:38 But as long as you're covered here, we're good to go.

07:41 So one thing I want you to talk about, we love these ABD pads as nurses because they're a little bit more absorbent, and the blue line goes to the sky.

07:54 And the more absorbent piece is on the wound.

07:57 So just keep that in mind with these.

07:59 These are called ABD pads.

08:01 And actually, in fact, we do use these a lot for abdominal wounds because they're much bigger, and they're absorbent.

08:08 So once I've done this and I've applied the wound dressing, now's a good time to go ahead and secure this.

08:15 So I can go ahead and take my tape, what we want to do is a window type dressing.

08:19 So I'll show you how to do that.

08:24 So also just keep in mind that when you are taping this down, every patient has different allergy.

08:32 So I'm using this, this plastic tape.

08:35 If your patient has adhesive allergies, note that as well.

08:38 There's different options we can use.

08:41 So as you see when I'm doing the window, I'm just tearing pieces and truly going to each side to enclose that.

08:49 Now clearly this is kind of an odd shape wound.

08:51 You would have much more body service to do on a patient but the whole point is to make a window with the dressing in the middle.

09:03 If you can minimize the amount of tape on the patient's skin, while also securing it down is ideal.

09:11 You can imagine how much tape can get on a patient's skin when we keep having to change the dressing.

09:22 Okay, so we would tape this down in a window like fashion.

09:25 Again, you would go that bottom, top, sides or whichever order just to make a window here.

09:36 Now before you leave, don't forget like we've seen earlier with the previous shift to make sure that you initial, then you're going to date and you're going to time your dressing.

09:46 Because when the new shift comes on, then we'll know when the last dressing was done.

09:56 Once we've completed irrigation, we want to go ahead dispose all of the soiled equipment.

10:01 Assist the patient back into a comfortable position.

10:04 Place a bed to the lowest position for safety.

10:07 Remove our gloves, perform our hand hygiene.

10:11 And don't forget to reassess the patient's pain.

10:14 That procedure, again, could be a little uncomfortable for the patient.

10:17 So make sure you're reassess and treat accordingly.

10:20 And of course, don't forget to document.

10:23 Let's look at a few considerations regarding wound irrigation.

10:27 So there's some possible complications that can occur.

10:30 Anytime you expose the wound, there's increased risk of infection.

10:34 And of course, we talked about when you irrigate, some of that forcing a fluid inside the wound can increase the level of pain for your patient.

10:43 And don't forget to assess out that skin that's surrounding the wound, we call this Peri-wound and this can be excoriated read and uncomfortable.

10:53 And again, let's look at these points, these considerations that's really important when you're talking about wound care.

10:59 Now, irrigation solutions are great, but they're usually a part of wound care orders.

11:04 Most of the time, this is going to be sterile normal saline, but make sure you assess, check your physician's order, because this can vary.

11:13 Now, here's a really important topic.

11:15 And sometimes this gets students confused.

11:18 If we need to culture the world, meaning that we get in there and we take tissue and we send it to the lab and check to see if there's any sort of infection going on or if it's growing something odd, we need to treat, we actually want to cleanse the wound first, and then get the culture.

11:36 That may seem kind of backwards.

11:38 But if you think about it, if you've got an open wound, sometimes there's some extra stuff in the air or bacteria or microbes.

11:46 That's not what we want to test, we want to test actually the wound bed.

11:51 So we want to cleanse first, and then culture.

11:53 So don't forget that point.

11:55 Now, a few more points here, and we've talked about this a little bit.

11:59 Wound care can be very painful.

12:01 So again, make sure you treat accordingly and premedicate if you're able to.

12:06 So one of the last considerations to keep in mind.

12:09 Some healthcare facilities have an excellent wound care team.

12:12 These are nurses that have advanced training in the treatment of wound care, thank goodness for them.

12:19 But many times they're going to be the ones that track the progression and the healing of the wound.

12:24 So because we don't want those wound expose the air any more than we have to, make sure you coordinate with the wound care team.