Wound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?
Trick of the Trade: “Squirt bottle” irrigation setup
Equipment
- A 500 cc bottle of sterile water or normal saline (bottle of drinking water could even work if not in a clinical environment)
- Eye protection
- Alcohol swab
- 18- or 20-gauge needle
Technique
- Clean the side of the bottle with an alcohol wipe
- Use the needle to puncture the top or side of the irrigation bottle 10-20 times in an evenly spaced pattern. If you are having trouble puncturing the side of the container you can luer-lock the needle onto a syringe for a better grasp.
- Firmly squeeze the container to get a strong stream of pressurized fluid until the bottle runs dry.
This irrigation trick works particularly well for cleaning out scalp wounds with a densely matted blood.
Caution: Need personal protective equipment
Because method does not protect from splatter, gloves and a face mask with eye shield is mandatory. A gown is recommended.
Caution: Use this trick only for wounds with a low infection risk
In wounds which require high-pressure irrigation, such as contaminated lower extremity wounds or bite wounds, this method may not achieve acceptable pressures.
Corollary Trick of the Trade: “Hair Salon” Irrigation Fluid Collection
To be extra fancy and maintain a dry field, use the “hair salon” technique to collect the irrigation fluid in a plastic wash basin [previous trick of the trade]. Learned from Paul Schneider, a paramedic and one of our best ED techs, a cut a slot for the injured extremity. Padding the sharp edges of the basin provides added patient comfort.
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