The fluid dynamics of simultaneous irrigation with negative pressure wound therapy

Abstract

Saline irrigation has been shown to be both experimentally and clinically efficacious in decreasing bacterial contamination as well as decreasing infection rates. The dynamics of irrigation delivery fall into two primary categories: simultaneous and intermittent irrigation. An important component to irrigation therapy is distribution of irrigation solution to hard-to-reach areas of a wound bed, including undermining and fissure-like structures. Here we test the effectiveness of simultaneous irrigation to fill the irregular structures of a wound bed. In order to visualise the dynamic movement of irrigation solution, three-dimensional wound models were constructed using clear synthetic ballistic gel. Wounds with the aforementioned characteristics were carved into the ballistic gel with varying area, depth and volume. All three wounds were dressed as per manufacturer's instructions. Data demonstrate that simultaneous irrigation is effective in reaching all parts of a wound bed in wound models that have both undermining and tunnelling, and irrigation effectively saturates bridged wounds. Finally, this study shows that there is constant turnover of irrigation solution in the wound that is driven more by administration volume and less by flow rate. These data show that simultaneous irrigation is an effective technique for delivering irrigation solution to both simple and complex wounds.

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

“…However, as the equipment diffuses the fluid to irrigate the wound, not even the most up-to-date machines can make the fluid target a specific point. In their investigation of the fluid dynamics of NPWT with simultaneous instillation, Davis et al [10] found that though the instillation fluid spreads out rapidly in the demonstration model, the equipment fails to sufficiently cleanse the beds of deep and narrow wounds, as the bed rarely comes into contact with the NPWT sponge. Therefore, NPWT with instillation may not be suitable for cleansing the base of deep and narrow wounds.…”

Negative pressure wound therapy with instillation without open‐window thoracostomy for empyema

“…Although NPWTi‐d is effective for infected wounds, its setting has not yet received a unified view, and more effective methods are being sought. Since there are some reports about the flow of washing solution in NPWTi‐d , we considered the possibility that the washing might be made more efficient by changing the position where the tube was inserted. These drain holes were opened without assuming that non‐OWT NPWTi‐d would be used.…”

Negative Pressure Wound Therapy Devices With Instillation/Irrigation

“…Although not specific to this device, an evaluation of fluid dynamics in 3-dimensional wound models with simultaneous irrigation with NPWT demonstrated that fluid reached all areas of the model wounds, including tunneling and undermining. 4 Cork Medical Products (Indianapolis, Indiana) offers an irrigation option on its Nisus NPWT device. Its Cleanse Therapy Kit contains a port for irrigation on the same pad used to connect to suction.…”

“…The irrigant drip rate is controlled by a roller clamp. Although not specific to this device, an evaluation of fluid dynamics in 3-dimensional wound models with simultaneous irrigation with NPWT demonstrated that fluid reached all areas of the model wounds, including tunneling and undermining 4…”