Wound lavage solutions

WOUND LAVAGE SOLUTIONS

  • Wound lavage solution should have ideal antiseptic properties with minimal cytotoxicity. They are used primarily in the initial phases of wound management to decrease bacterial load and remove  the necrotic tissue and debris. Once the wound is clean, balanced electrolyte or physiologic saline solutions are ideal for cleansing it.
  • Tap water is not an ideal wound cleanser, but is acceptable  initially to remove dirt and debris when there is severe contamination. Its hypotonicity causes cell swelling, which can cause significant cell destruction and delay wound healing with prolonged use.
  • Antiseptic solutions are contraindicated in clean wounds because all antiseptics have some cytotoxic effects and may do more harm than good.

Chlorhexidine diacetate

  • The preferred wound lavage and wetting solution is 0.05% chlorhexidine diacetate because of its wide spectrum of antimicrobial activity and sustained residual activity.
  • It has antibacterial activity in the presence of blood and other organic debris, has minimal systemic absorption and toxicity, and promotes rapid healing. Residual activity may last as long as 2nd  day, and effectiveness increases with repeated  applications.
  • Potential drawbacks of chlorhexidine include resistance to Proteus, Pseudomonas, and Candida, and corneal toxicity.

Povidone-iodine

  • A 1% or 0.1% povidone-iodine is used frequently for wound lavage because of its wide spectrum of antimicrobial activity. Iodine compounds are active against vegetative and sporulated bacteria, fungi, viruses, protozoa, and yeasts.
  • A 0.1% solution is recommended. This concentration kills bacteria within 15 seconds, and there is no known bacterial resistance. Residual activity lasts only 4 to 8 hours and organic matter inactivates the free iodine in povidone-iodine.
  • It is absorbed to the system through the skin and mucous thus excess systemic concentration causes transient thyroid dysfunction. Its low pH can cause or intensify metabolic acidosis when it is absorbed.
  • Scrubbing wounds with povidone-iodine detergents damages tissues and potentiate infection.

Other Solutions

  • Acetic acid at 0.25% or 0.5% occasionally is used as lavage solution. Its antibacterial effect is achieved by lowering wound pH.
  • It is more cytotoxic to fibroblasts than  bacteria.

a) Hydrogen peroxide, even in low concentrations, damages tissue and is poor antiseptic. It is an effective sporicide.

  • Hydrogen peroxide when applied as lavage is converted into foam and oxygen by tissue catalases when it contacts wound tissue.
  • It has a brief period of antimicrobial action, and it does not penetrate the tissues.
  • Hydrogen peroxide should be used to irrigate wounds out should not be delivered to wounds under pressure. It  should not be  delivered to wounds under pressure.
  • It does not require any special after care. The foaming action of hydrogen peroxide may be beneficial in removing dirt and debris from deep wounds when used in initial wound management.
  • It may also be  beneficial for removing clots from the wound and in obtaining hemostasis.
  • It has minimal bactericidal potency, but more sporicide action .At 3% concentration it injures tissues.

b) Dakin’s solution is a 5% solution of sodium hypochlorite (1:10 dilution of laundry bleach). It is detrimental to neutrophils, fibroblasts, and endothelial cells and therefore should not be used as a wound lavage solution.

c) Sterile normal saline 0.9% - used for irrigation

d) Hyper tonic saline 2.5% - Cleaning & antibacterial activity

e) Isotonic saline, lactated ringers (or) Ringers Lactate

  • These are used for lavaging the infected wounds to reduce the amount of bacteria in the wound by means of their lavage action.
  • It requires no special after care. These solutions cause no damage to tissues. These solutions do not have any antibacterial properties.
Last modified: Wednesday, 9 May 2012, 5:56 AM