by lswezey on September 30, 2009
Continuing our series on adjunctive therapies, this week we will examine the use of pulsed lavage in wound care.
Treatment Overview
Pulsed lavage (pulsatile jet lavage) is mechanical water therapy used to assist in debriding wounds of necrotic tissue. It utilizes a pressurized pulsed solution, sometimes in conjunction with suction, to help rid the wound of debris. It is thought that pulsed lavage improves the development of healthy, granulating tissue. The goal is to remove unwanted tissue without disturbing healthy tissue. The pressure of irrigation is measured in pounds per square inch (psi), and a pressure of 4 to 15 psi is considered safe and effective. Normal saline is the most commonly used irrigating solution.
Indications
- Cleansing/debriding a variety of wounds, including venous, pressure and neuropathic ulcers
- Burns
- Traumatic wounds
- Surgical wounds
- Patients who are not candidates for whirlpool therapy due to health condition (i.e. venous insufficiency, incontinence, certain cardiac conditions, patients in an ICU)
- Wounds with tunnelling (if the lavage system has the correct tips)
Contraindications
- No absolute contraindications exist when a psi of 15 or less is used
- Some wounds may be better suited for whirlpool therapy due to their nature (i.e. extensive burns, psoriasis, Kaposi’s sarcoma)
Advantages
- Greater amount of debridement can be obtained by increasing the psi
- Antibiotics can be added to the irrigation fluid to help reduce the wound’s bioburden
- Pulsed lavage is relatively cost-effective
- Pulsed lavage systems are easily mobile and can be used in a variety of patient care settings
- Decreased risk of contamination of the wound in comparison to whirlpool therapy
- Decreased risk of maceration of healthy surrounding tissue, as may occur with whirlpool therapy
- The technician can easily control the pressure applied to the wound
Disadvantages
- Pulsed lavage can be a painful procedure for some patients
- Cooling of the wound bed may occur when the irrigating solution is not sufficiently warm, resulting in a delay in wound healing
- Pulsed lavage is time consuming- treatments may take 15 to 30 minutes and may need to be done daily (twice daily if the wound has more than 50% necrosis)
For patients who experience pain during the procedure, appropriate pain medications can be administered 30 minutes prior to treatment; alternately, a topical anaesthetic, such as lidocaine, can be used to ease discomfort. In addition, the psi can be decreased if pain still persists despite use of other methods of pain relief.
Interested in becoming certified in wound care management? Woundeducators.com is your online resource for the most comprehensive wound care information available, and can help you take the next step in your career. Contact us today for more information.
Sources:
Bastawros, D. (2003) 5 things you need to know about: Pulsed lavage. Advances in Skin
& Wound Care; Nov 16(6), p. 282
Loehne, H. & Scott, R. (2000). Treatment options: 5 questions–and answers–about pulsed lavage. Advances in Skin & Wound Care, May/June.
by lswezey on September 23, 2009
We have completed our series on wound dressings. We hope you found them enjoyable and informative. We will now be turning our attention to adjunctive therapies in wound care, covering topics as diverse as laser therapy, ultrasound, negative-pressure wound therapy and this week’s topic, whirlpool therapy.
Whirlpool therapy is thought to affect the inflammatory phase of healing, and can be used on a variety of wounds. Whirlpool tanks can be installed (permanent) or portable, and may be used for full-body immersion or for a single extremity. Settings can be adjusted, depending on the direction of turbulence and force of agitation deemed necessary. Different settings of temperature can also be used to differentiate the whirlpool’s effect on circulation.
Indications
- Wounds with moderate to heavy exudate
- Wounds with debris
- Necrotic wounds
- Ischemic wounds
- Wounds with tissue able to withstand increased circulation to the wound
Contraindications
- Clean granulating wounds can be traumatized by even gentle water agitation
- Epithelializing wounds
- Wounds with skin grafts, which may be damaged by agitation of water
- Venous ulcers because, by their very nature, they already suffer problems with circulation
- Diabetic ulcers which are non-necrotic, because the callous formation will be disrupted, and tissue maceration will lead to a wound that may enlarge
- Edema to an extremity
- Upper extremity infection
- Presence of dry gangrene
- In addition, patients who have renal failure, circulatory or pulmonary disease, acute phlebitis, are febrile, lethargic or unresponsive, or who are incontinent of urine or feces should not use whirlpool therapy
- Spinal cord-injured patients and those with peripheral neuropathy are at risk for thermal injury or hypothermia when whirlpool therapy is used
Advantages
- Softens necrotic tissue, facilitating its removal (mechanical debridement)
Increases blood flow to the wound (improves circulation, which brings an influx of oxygen and nutrients to the tissues)
- Cleanses the wound(s)
- Helps to remove exudate, which decreases risk of infection
- Analgesia is induced by the effects of the warm water on the wound
Disadvantages
- Sensitive patients may develop allergies to the chemical agents used in whirlpool therapy
- Improper cleansing of the whirlpool may lead to wound infection
- Obese persons may not be candidates for whirlpool therapy because of their inability to disperse heat effectively
- Whirlpool therapy is time-consuming (treatments often given for 20 minutes twice a day, after which wounds should be dressed)
- Treatment can be expensive in terms of supplies, dressings, and labour
The temperature of the water used in whirlpool therapy should be based on wound and client condition. Water temperature should not exceed 1 degree above skin temperature in clients with peripheral vascular disease (PVD) and should not exceed 38 degrees Celsius in patients with heart or lung disease. When the water temperature must be lower, take care to ensure the client does not become chilled by keeping the therapy room warm and free of drafts. Where possible, immerse a single limb rather than the entire body.
Join us weekly as we explore the many different treatment modalities available for managing wounds. If you are interested in becoming certified in wound management, please visit www.woundeducators.com.
Sources:
Bates-Jensen & Sussman, C. (1998) Wound Care Collaborative Manual for Physical Therapists and Nurses, Aspen Publishers.