tangent
12-12-01, 03:12
> Stan <sroberts@cas.org> wrote:
>
> >Piercing a pinhole in a plastic bag, filling the bag with
> >saline or clean water, and squeezing will produce a useful
> >irrigation flow.
> >
> >If you have a bottle of normal saline, here is a procedure which can
> >also be used:
> >
> >
> >Wound Irrigation Alternative
> >
> >[Clinician Reviews 7(10):89, 1997.]
> >
> >An effective wound irrigation system can be made using a 250-cc
> >plastic bottle of normal saline. Remove the protective outer
> >cover to reveal the sterile screw-cap underneath (do not
> >unscrew). Using an 18-gauge syringe needle, carefully punch a
> >hole in the top of the plastic screw-cap. The bottle can then be
> >squeezed to produce a jet of sterile saline for wound
> >irrigation. This technique is more convenient than using a
> >syringe and intravenous catheter as it provides 250 cc of saline
> >without needing to reload.
> >
> > Ronald A. Berry, RN, MS, FNP
> > Lander, Wyo
>
> Only problem I see is lack of enough pressure. The typical 35 or 12
> cc syringe is recomended as it is the largest size that will generate
> enough pressure with most ER docs/PAs. 10 psi is needed for maximum
> efectiveness, and there is no way to get that kind of pressure from
> squezing a bottle. While it's better then nothing, it is pretty weak
> for pressure irrigation.
>
The pressure is indeed on the low side, but it is useful for rapid
irrigation of large wounds - especially abrasions and burns.
A few words on pressure irrigation may be in order here.
The goal of prssure irrigation is to "wash out" bacteria and
debris (bits of dirt, dead tissue, etc.). If you don't have
enough pressure, you won't wash out much. In general, the
minimum pressure to have an effect greater than just pouring
a bit of saline into a wound and then taking it out again
(which is useful, as it gets rid of free bacteria and debris,
and may dissolve stuff, just not as useful as pressure irrigation)
is considered to be 4 psi. You get 6-8 psi with the plastic
bag, 4.5-5 psi with the bottle (unless you have really strong
hands :smile:. In general, the more pressure the better _up to
a point_ . Anything above 15 psi tends to have negative effects
such as forcing bacteria into healthy tissue and tearing
healthy tissue. Pat's statement about 10 psi being optimum
is not something too many people would quarrel with (I
certainly don't, anyway).
Some numbers for various items which have been
used for irrigation:
Device Irrigation pressure
(psi)
Spray Bottle 1.2 \ useful for getting
> some cleaning, but
Bulb syringe 2.0 / not really pressure
irrigation
Piston irrigation
syringe with 4.2
catheter tip
Water Pik (TM)
at lowest setting 6.0
Irrijet (TM) DS syringe
with tip 7.6
35 ml syringe with
19 gauge needle or 8.0
angiocatheter
Water Pik (TM)
at middle setting 42 {too high for safe irrigation}
(Numbers from K. A. Beltran, et al, unpublished report, 1994, as
reported in Clinical Practice Guideline Number 15, Treatment of
Pressure Ulcers, USDHHS, December 1994)
Some references for those desiring to read more:
G. T. Rodeheaver, et al "Wound cleansing by high pressure
irrigation," Surg. Gynecol. Obstet. 1975 Sep;141(3):357-62
C. B. Wheeler, et al "Side-effects of high pressure irrigation,"
Surg. Gynecol. Obstet. 1976 Nov;143(5):775-8
************************************************** ****************************
Renegade academician. They're a dangerous breed when they go feral,
academics are...a chemist, too.
--(James P. Blaylock in "Lord Kelvin's Machine")
My organization hasn't agreed with any of my opinions so far, and
I doubt they'll start now.
Stanley Roberts
--------
Just to add one more datapoint
19 ga cathater with 12 ml syringe gives 15 PSI. Probally to much work
for routine injuries, but when maximum effectiveness is required it
can be used.
Pat
------
Are you saying 4.5-5 PSI for squeezing a 250 ml bottle? Thats higher
than I would have thought. If you clasp the bottle between the hands
and squeeze, I would think the minimum contact area possable for a
male would be 10 sq inches (5"x2"), and that would be increased due to
the rigidity of the bottle. Anyway 5 PSI would require a force of 50
lbs with no force transfer from the walls of the bottle (even higher
in reality). I guess that's possable for a male in good shape.
In that case it would work even better then I thought.
You would have to be careful to keep the orifice real small, or you
will never develop maximum pressure (ie a bulb syringe, which in
theory could develop the same pressure, is rated at .05 PSI)
Thanks for the informative reply
Pat
-----------
>
> >Piercing a pinhole in a plastic bag, filling the bag with
> >saline or clean water, and squeezing will produce a useful
> >irrigation flow.
> >
> >If you have a bottle of normal saline, here is a procedure which can
> >also be used:
> >
> >
> >Wound Irrigation Alternative
> >
> >[Clinician Reviews 7(10):89, 1997.]
> >
> >An effective wound irrigation system can be made using a 250-cc
> >plastic bottle of normal saline. Remove the protective outer
> >cover to reveal the sterile screw-cap underneath (do not
> >unscrew). Using an 18-gauge syringe needle, carefully punch a
> >hole in the top of the plastic screw-cap. The bottle can then be
> >squeezed to produce a jet of sterile saline for wound
> >irrigation. This technique is more convenient than using a
> >syringe and intravenous catheter as it provides 250 cc of saline
> >without needing to reload.
> >
> > Ronald A. Berry, RN, MS, FNP
> > Lander, Wyo
>
> Only problem I see is lack of enough pressure. The typical 35 or 12
> cc syringe is recomended as it is the largest size that will generate
> enough pressure with most ER docs/PAs. 10 psi is needed for maximum
> efectiveness, and there is no way to get that kind of pressure from
> squezing a bottle. While it's better then nothing, it is pretty weak
> for pressure irrigation.
>
The pressure is indeed on the low side, but it is useful for rapid
irrigation of large wounds - especially abrasions and burns.
A few words on pressure irrigation may be in order here.
The goal of prssure irrigation is to "wash out" bacteria and
debris (bits of dirt, dead tissue, etc.). If you don't have
enough pressure, you won't wash out much. In general, the
minimum pressure to have an effect greater than just pouring
a bit of saline into a wound and then taking it out again
(which is useful, as it gets rid of free bacteria and debris,
and may dissolve stuff, just not as useful as pressure irrigation)
is considered to be 4 psi. You get 6-8 psi with the plastic
bag, 4.5-5 psi with the bottle (unless you have really strong
hands :smile:. In general, the more pressure the better _up to
a point_ . Anything above 15 psi tends to have negative effects
such as forcing bacteria into healthy tissue and tearing
healthy tissue. Pat's statement about 10 psi being optimum
is not something too many people would quarrel with (I
certainly don't, anyway).
Some numbers for various items which have been
used for irrigation:
Device Irrigation pressure
(psi)
Spray Bottle 1.2 \ useful for getting
> some cleaning, but
Bulb syringe 2.0 / not really pressure
irrigation
Piston irrigation
syringe with 4.2
catheter tip
Water Pik (TM)
at lowest setting 6.0
Irrijet (TM) DS syringe
with tip 7.6
35 ml syringe with
19 gauge needle or 8.0
angiocatheter
Water Pik (TM)
at middle setting 42 {too high for safe irrigation}
(Numbers from K. A. Beltran, et al, unpublished report, 1994, as
reported in Clinical Practice Guideline Number 15, Treatment of
Pressure Ulcers, USDHHS, December 1994)
Some references for those desiring to read more:
G. T. Rodeheaver, et al "Wound cleansing by high pressure
irrigation," Surg. Gynecol. Obstet. 1975 Sep;141(3):357-62
C. B. Wheeler, et al "Side-effects of high pressure irrigation,"
Surg. Gynecol. Obstet. 1976 Nov;143(5):775-8
************************************************** ****************************
Renegade academician. They're a dangerous breed when they go feral,
academics are...a chemist, too.
--(James P. Blaylock in "Lord Kelvin's Machine")
My organization hasn't agreed with any of my opinions so far, and
I doubt they'll start now.
Stanley Roberts
--------
Just to add one more datapoint
19 ga cathater with 12 ml syringe gives 15 PSI. Probally to much work
for routine injuries, but when maximum effectiveness is required it
can be used.
Pat
------
Are you saying 4.5-5 PSI for squeezing a 250 ml bottle? Thats higher
than I would have thought. If you clasp the bottle between the hands
and squeeze, I would think the minimum contact area possable for a
male would be 10 sq inches (5"x2"), and that would be increased due to
the rigidity of the bottle. Anyway 5 PSI would require a force of 50
lbs with no force transfer from the walls of the bottle (even higher
in reality). I guess that's possable for a male in good shape.
In that case it would work even better then I thought.
You would have to be careful to keep the orifice real small, or you
will never develop maximum pressure (ie a bulb syringe, which in
theory could develop the same pressure, is rated at .05 PSI)
Thanks for the informative reply
Pat
-----------