Comparison of Irrigation Times Using Gravity and High-Pressure Lavage

Abstract

The benefits of high-pressure pulsatile lavage for open fracture irrigation have been controversial based on conflicting experimental animal research. Recently published data definitively demonstrated that irrigation pressure does not affect the incidence of reoperation for the treatment of open fractures. However, proponents of pulsatile lavage argue a faster irrigation time is an important benefit of the high-pressure treatment. The purpose of this study was to determine the difference in irrigation time between gravity and high-pressure lavage. The experimental setup was designed to mimic clinical practice and compared mean irrigation flow times for high-pressure pulsatile lavage and gravity flow with 2 commonly used tube diameters. Each irrigation setup was tested 5 times at 3 different irrigation bag heights. Analysis of variance and Student's t tests were used to compare the mean flow times of 3 irrigation methods at each height and among the 3 heights for each irrigation method. The mean irrigation flow time in the various experimental models ranged from 161 to 243 seconds. Gravity irrigation with wide tubing was significantly faster than pulsatile lavage or gravity with narrow tubing (P<.001). Increasing irrigation bag height had only a marginal effect on the overall flow times (<9% difference). The difference in mean flow time among the testing techniques was slightly longer than 1 minute, which is unlikely to have a material impact on procedural costs, operating times, and subsequent gains in patient safety. [Orthopedics. 2017; 40(3):e413-e416.].

Cleansing and Care of a Deep and Narrow Wound with Easily Accessible Medical Equipment

“…They managed patients with deep sternal wound infections after cardiac surgery with continuous suction-irrigation drainage and claimed successful outcomes [6]. Using pulsed lavage to cleanse a wound has also been reported by many authors [7,8]. Moreover, Yang and Dai [4] have presented the use of a side-hole double-valve lavage tube as an improvement on conventional lavage techniques.…”

Go with the flow: An experimental analysis with tubing alternative with irrigation

“…24 Along the same lines, Muscatelli et al described a decrease in flow time with increasing height. 25 It is recommended that the highest possible position of bag height be used to help administer the fluid. 24,25 Currently, cystoscopy tubing is the most commonly used gravity irrigation method to deliver the irrigant to the wound.…”

“…25 It is recommended that the highest possible position of bag height be used to help administer the fluid. 24,25 Currently, cystoscopy tubing is the most commonly used gravity irrigation method to deliver the irrigant to the wound. 25 There is a paucity of literature evaluating alternative gravity pressure methods.…”

“…24,25 Currently, cystoscopy tubing is the most commonly used gravity irrigation method to deliver the irrigant to the wound. 25 There is a paucity of literature evaluating alternative gravity pressure methods. 25 The purpose of this study is to compare alternative methods of wound irrigation to the current standards.…”

“…This can be simply explained by the gravitation pull on the water; however, Mundy et al showed faster emptying of irrigant for gravity‐administered fluid compared with pulse lavage at increasing hanging height 24 . Along the same lines, Muscatelli et al described a decrease in flow time with increasing height 25 . It is recommended that the highest possible position of bag height be used to help administer the fluid 24,25 …”