Pulsed Lavage: Improving Wound Irrigation

The use of irrigation has long been known to reduce bacterial content. Whirlpool therapy, one of the oldest adjuvant forms of treatment for wounds still in use today,1,2 is a popular form of wound irrigation. However, this therapy is gradually being replaced by the technique known as pulsed lavage.2

LJ Haynes Study

The move towards pulsed lavage began with a study by Haynes and colleagues which showed that the rate of granulation tissue formation was significantly higher in those patients receiving pulsed lavage compared with those undergoing whirlpool therapy.3 Further research is necessary, but it has been predicted that pulsed lavage will ultimately replace whirlpool for wound irrigation and cleansing in patients who can tolerate this therapy.2

Pulsed Lavage Technique

The technique of pulsed lavage involves delivering an irrigating solution at a pressure by means of a powered device. There has been some debate in the literature concerning the optimal pressure, but a pressure of around 10–15 psi has been shown to effectively remove debris, decrease bacterial colonization and prevent clinical infection.4-6

Pulsed Lavage Indications

Pulsed lavage is indicated for cleansing or debriding wounds due to arterial insufficiency, venous insufficiency, diabetes, pressure, small burns, surgery, or trauma and is also appropriate for tunneling or undermining wounds. However, the technique should not be used near exposed arteries, tendons, nerves, capsules, or bones, and should not be used in body cavities, facial wounds, on recent grafts or surgical procedures, or on actively bleeding wounds. Furthermore, caution should be used in patients taking anticoagulants, insensate patients, and deep tunneling wounds

Advantages of Pulsed Lavage

The principal advantages of pulsed lavage over whirlpool therapy include the shorter treatment times required, the reduced cost, and reduced stress for patients. In addition, pulsed lavage has a lower risk of cross-contamination than whirlpool therapy. However, unlike whirlpool therapy, pulsed lavage is not suitable for extensive wounds, and is not able to offer sterile conditions after the initial treatment.

Further information about adjuvant therapies including pulsed lavage can be learnt by studying for a certification in wound care. Wound care certification is an ideal way to refresh your knowledge and learn new techniques, while demonstrating a commitment to this important and growing area.

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Interested in learning more about wound care and certification? Browse through our wound care certification courses for information on our comprehensive range of education options to suit healthcare professionals across the full spectrum of qualifications and experience.

References

1. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
2. Hess CL, Howard MA, Attinger CE. A review of mechanical adjuncts in wound healing: hydrotherapy, ultrasound, negative pressure therapy, hyperbaric oxygen, and electrostimulation. Ann Plast Surg. 2003 Aug;51(2):210-8.
3. Haynes LJ, Brown MH, Handley BC, et al. Comparison of Pulsavac and sterile whirlpool regarding the promotion of tissue granulation. Phys Ther 1994;74(suppl):S4
4. Madden J, Edlich RE, Schauerhamer R. Application of principles of fluid dynamics to surgical wound irrigation. Current Topics in Surg Res 1971;3:85-93
5. Green VA, Carson HC, Briggs RL, Stewart JL. A comparison of the efficacy of pulsed mechanical lavage with that of rubber-bulb syringe irrigation in removal of debris from avulsive wounds. Oral Surg Oral Med Oral Pathol 1971;32:158-164
6. Rodeheaver GT, Pettry D, Thacker JG, et al. Wound cleansing by high pressure irrigation. Surg Gynecol Obstet 1975;141:357-362