Continuing our series on adjunctive therapies, this week we will examine the use of pulsed lavage in wound care.

Treatment Overview

Pulsed lavage (pulsatile jet lavage) is mechanical water therapy used to assist in debriding wounds of necrotic tissue. It utilizes a pressurized pulsed solution, sometimes in conjunction with suction, to help rid the wound of debris. It is thought that pulsed lavage improves the development of healthy, granulating tissue. The goal is to remove unwanted tissue without disturbing healthy tissue. The pressure of irrigation is measured in pounds per square inch (psi), and a pressure of 4 to 15 psi is considered safe and effective. Normal saline is the most commonly used irrigating solution.

Indications

• Cleansing/debriding a variety of wounds, including venous, pressure and neuropathic ulcers
• Burns
• Traumatic wounds
• Surgical wounds
• Patients who are not candidates for whirlpool therapy due to health condition (i.e. venous insufficiency, incontinence, certain cardiac conditions, patients in an ICU)
• Wounds with tunnelling (if the lavage system has the correct tips)

Contraindications

• No absolute contraindications exist when a psi of 15 or less is used
• Some wounds may be better suited for whirlpool therapy due to their nature (i.e. extensive burns, psoriasis, Kaposi’s sarcoma)

Advantages

• Greater amount of debridement can be obtained by increasing the psi
• Antibiotics can be added to the irrigation fluid to help reduce the wound’s bioburden
• Pulsed lavage is relatively cost-effective
• Pulsed lavage systems are easily mobile and can be used in a variety of patient care settings
• Decreased risk of contamination of the wound in comparison to whirlpool therapy
• Decreased risk of maceration of healthy surrounding tissue, as may occur with whirlpool therapy
• The technician can easily control the pressure applied to the wound

Disadvantages

• Pulsed lavage can be a painful procedure for some patients
• Cooling of the wound bed may occur when the irrigating solution is not sufficiently warm, resulting in a delay in wound healing
• Pulsed lavage is time consuming- treatments may take 15 to 30 minutes and may need to be done daily (twice daily if the wound has more than 50% necrosis)

For patients who experience pain during the procedure, appropriate pain medications can be administered 30 minutes prior to treatment; alternately, a topical anaesthetic, such as lidocaine, can be used to ease discomfort. In addition, the psi can be decreased if pain still persists despite use of other methods of pain relief.

Many of us have our prescriptions filled at various pharmacies, instead of just one pharmacy. Often, this is for the sake of convenience, while at other times it is for the sake of saving a few dollars or cents. In most cases, spreading the pharmacy love around town is a huge mistake that could be detrimental to your health in the long run.

If you use one pharmacy for all of your medications, this is safer. Your pharmacist will have records for every medication he or she has filled for you in the past, which could essentially save your life. It is also easier to discuss medications and your health with a pharmacist that you are used to doing business with. He or she has as much of a stake in your health as you and your doctor.

There are other reasons for using one pharmacy as well - especially when you use a small, privately owned pharmacy. When you need over-the-counter medications, you should buy them at the pharmacy that you always use - even if the OTC medication costs less elsewhere. You walk up to the counter, put your OTC medication selection on the counter, and wait for your friendly pharmacist to ring it up. He says ‘wait a minute,’ and walks over to his computer, where he brings up your pharmacy records.

He informs you that you cannot take this over the counter medication, because you are taking a prescription medication for a health condition, and that combining the two is dangerous, or at the very least makes one or the other - or both medications - ineffective. He may have just saved your life, and that is service that you won’t get at a big pharmacy where nobody knows or cares who you are or what you are taking.

If your pharmacist doesn’t wait on you personally, and you have an ongoing health condition, or you take prescription medication regularly, you can always ask your pharmacist to recommend a safe over-the-counter medication, and remind him of the medication that you currently take, or the health condition that you have.

Pharmacists are full of great information as well. In fact, in some situations they can save you a trip to the doctor. Note that they do not offer medical advice, or medical diagnosis. But they can listen to what you have to say and recommend an over the counter medication, or tell you point-blank that you need to see your doctor.