00:04
Hi, guys, welcome to the
skill wound irrigation.
00:07
So there's a few instances that
you may use this in your practice.
00:11
So the first one, just remember,
we're irrigating because a lot of
times a wound can be extra draining
there's a lot of extra tissue.
00:19
We may irrigate it just to make sure we
can assess the wound bed more accurately.
00:24
Also, it's pretty typical to irrigate
a wound before a dressing change.
00:29
And we definitely irrigate or cleanse
the wound before obtain a wound culture.
00:34
So now let's take a look at
what we're going to need.
00:36
We need a basin to catch
all of the irrigation fluid,
and of course and get
a little bit messy,
so we're going to
need absorbent pad.
00:44
So just depending on
the size of the wound,
we definitely want to consider
PPE that's appropriate.
00:50
Now, of course,
irrigation solutions are going to vary
depending on the
physician order.
00:55
Sterile normal saline is a really
common irrigation solution.
01:00
And of course,
some sort of container to pull it in.
01:03
And we're also going to need a device
to actually irrigate the wound.
01:07
Now if we're doing a dressing change,
we may need a sterile dressing
and sterile gauze may be indicated
to help cleanse the wound.
01:14
So to start our procedure, of course,
you want to perform your hand hygiene
and provide privacy
to your patient.
01:20
It's important to hear
to explain the procedure.
01:24
Just know depending
on the wound,
some of these wounds are pretty
big that we are dealing with.
01:29
When we irrigate
or we cleanse it,
there definitely
could be some pain.
01:33
So we need to assess that as a nurse,
and premedicate if at all possible.
01:38
And for appropriate
body mechanics,
make sure you raise the bed to
an appropriate working height,
and also assist the patient
in a proper position.
01:47
Now we want to go ahead and put
on gloves and this is a great time
to put absorbent pad underneath
the side you're going to irrigate
and protect those linens.
01:56
Once we put the pad down, you want to
put the basin under the wound as well.
02:01
This is what's going to catch all that
irrigation fluid you're going to use.
02:06
Now if there's a dressing
on the patient's wound,
this is the time to go ahead and
remove that old dressing that's soiled.
02:13
Get rid of that and
remove your gloves.
02:16
We're going to perform
our hand hygiene.
02:22
Hey guys, welcome to the live
demo of wound irrigation.
02:26
Just know this skill is
going to vary quite a bit
depending if you're going to
irrigate a pretty small wound
versus a really big deep one.
02:34
And of course, it's going to
be much easier to even irrigate
maybe an arm wound versus
one on the abdomen.
02:40
So seek out assistance if
you need help with this.
02:43
So before we get started,
let's look at our equipment.
02:46
A basin's going to be really great
to catch all that irrigant fluid.
02:50
But of course, this is probably
only going to be useful,
if maybe you're irrigating a foot wound
or maybe one on the arm for example.
02:58
And as you can imagine
irrigation to get messy.
03:01
So make sure you
bring absorbent pads
because this can get all
over the patient's linen.
03:06
Also, when we're irrigating depending
on the severity of the wound,
you want to consider your PPE.
03:12
Reason being is when we're
irrigating, this could splash,
so you may want to consider eye protection,
for example, and of course gloves.
03:21
Now before we get much further,
I want to talk about gloves.
03:24
So there's lots of evidence
out there now that says
that we do not have
to use sterile gloves,
but make sure you use
your facilities policy.
03:33
So just keep that in mind.
03:35
Many general wound dressings now we use
clean technique, but sterile supplies.
03:41
Now when I say sterile supplies, that
means these things that are in the package.
03:45
So just pro tip for you.
03:48
Okay, the other thing to consider
is your irrigation solution.
03:52
So this is going to be specifically
ordered by your physician,
it's important to make sure before
you get started, you check that order.
04:00
And also another tip for you
as a nursing student or a nurse.
04:03
When you talk about
irrigation solution,
many times we're going
to use normal saline.
04:10
So just know, I don't know
why we make this hard on you.
04:14
Usually you're not going to see the
word normal saline on a bottle,
what you're actually going to see is 0.9%
sodium chloride, that is normal saline.
04:25
So if you're looking for it,
look for the 0.9% sodium chloride
that is our "normal saline".
04:30
And this is a really
common irrigation solution.
04:34
Next we want a container to
hold our irrigation solution,
so we can pull it up with our
catheter-tip syringe that we have here.
04:44
It's also a great idea to make sure
that you have sterile gauze, for example.
04:49
So once you irrigate,
a lot of times the wound bed can get
or excuse me, the wound,
the skin around it can get moist.
04:56
We don't want to
leave that there.
04:58
We want to grab the gauze
and and gently dry that skin.
05:02
And another pro tip
when you go to irrigate,
you're usually going to
have to redo the dressing.
05:08
So save yourself a trip and bring
all your sterile dressing supplies
with you to the room.
05:14
Now let's go ahead
and get started.
05:16
We want to perform our
hand hygiene of course,
and obviously provide privacy.
05:21
We want to explain this procedure
to the patient thoroughly.
05:24
Because sometimes, this can be a little
bit uncomfortable when you irrigate.
05:29
Think about you're putting a little bit of
fluid in the wound, a little bit pressure.
05:34
So make sure you assess the
patient's level of pain,
and make sure you premedicate,
if at all possible.
05:40
And of course,
anytime you're working with a patient,
if you can raise the bed to
an appropriate working height.
05:47
Now positioning is important because
depending if it's an arm and abdomen,
maybe on the back of the coccyx,
we're going to have to position
the patient for ideal irrigation.
05:59
Now let's go ahead
and put on our gloves.
06:09
Okay, so I'm going
to put on my gloves.
06:11
And as you can see here
with my model today,
it's a little bit clearly
not attached to a patient,
but this is what we're
going to work with.
06:18
We're going to place an absorbent
pad underneath the wound.
06:22
Now if we can, and if it was a,
maybe a foot wound
or an arm or a leg,
the basin will be great to
catch all that irrigation fluid.
06:32
So when we go into the room,
many times your wound is going
to have a dressing over it.
06:37
So we're going to
remove it at this time.
06:39
And then we're going to toss the soiled
dressing and remove the old gloves.
06:44
So also, I want to note here,
the previous shift was nice enough to
date, time and also initial.
06:52
The reason why we like to do that
is because we're going to know
when the last time this
dressing was changed.
06:59
And many times your order
is going to let you know
how often it needs
to be changed.
07:03
For example, daily, maybe twice
a day just depends on the wound,
something that I hadn't
removed that now.
07:17
Okay,
I'm going to remove my dressing
and I'm going to dispose of it.
07:21
And because I've touched
a soiled dressing,
I'm going to remove my gloves
and perform hand hygiene again.