RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Nursing Best Practice GuidelineIn order to establish and maintain a clean wound bed, the wound should be cleansed at each dressingchange (AHCPR, 1994; Consortium for Spinal Cord Medicine, 2000). Although there are no randomized controlledtrials regarding frequency of cleansing, ulcers should be cleansed prior to each dressing change withoutcausing chemical or mechanical trauma to the wound or surrounding tissue (Consortium for Spinal CordMedicine, 2000).To ensure adequate cleansing of the wound bed, a sufficient volume of irrigation fluid is essential. Thevolume suggested for irrigation is between 100 – 150 ml of solution. However, the panel emphasizes thatthe amount used should be enough to adequately rinse the entire surface. The AHCPR (1994) guidelinerecommends a range of irrigation pressure between 4 – 15 psi as irrigation pressures below 4 psi have beenfound to be inadequate for thorough wound cleansing. They report on several studies indicating thatpressurized irrigation was more effective in removing wound debris and bacteria than gravity or bulbsyringe irrigation. A study by Rodeheaver, Pettry, Thacker, Edgerton and Edlich (1975) found that theefficiency of wound irrigation in traumatic wounds is markedly improved by delivering the irrigant to thewound under continuous high pressure. Irrigation of the wound with saline solution delivered at 15pounds per square inch (psi) removed 84.8% of the soil infection potentiating factors from the wound.However, irrigation pressures that exceed 15 psi may cause wound trauma and force bacteria into thetissue. The work of Stevenson, Thacker, Rodeheaver, Baccetta, Edgerton, and Edlich (1976) found that highpressure irrigation at a psi of 8, achieved by using a 35 mL syringe with a 19-gauge needle, was sufficient tocleanse treated wounds of bacteria and reduce the risk of infection. The combination of a 35 mL syringewith a 19-gauge needle or angiocath has been recommended elsewhere as well (AHCPR, 1994; Consortium forSpinal Cord Medicine, 2000; Maklebust & Sieggreen, 1996). However, as this recommendation is based on thedocumented sizing from American research, differences in equipment availability in Canada may posechallenges to implementing this practice. As a result, the use of a 30 mL syringe with a 20-gauge needleor angiocath has been identified as a suitable Canadian equivalent (Rodeheaver, personal communication,February 14, 2003, with permission from C. Harris). Moreover, the use of an angiocath rather than a needle issuggested to reduce the danger from needle stick injuries (Maklebust & Sieggreen, 1996).41