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Pressure dynamics of various irrigation techniques commonly used in the emergency department
A J Singer1, J E Hollander, S Subramanian
1Department of Emergency Medicine, State University of New York at Stony Brook.
Study Objective:
To evaluate the pressure dynamics of common irrigation techniques used in the treatment of traumatic wounds.
Design:
Matched experimental trial.
Participants:
Ten male volunteers.
Interventions:
Pressure curves were obtained while performing manual irrigation with 250-mL boluses of normal saline with 19-gauge needles on 35-mL syringes, 19-gauge needles on 65-mL syringes, IV bags pierced with 19-gauge needles, and plastic bottles pierced with 19-gauge needles. Measurements also were obtained using an IV bag with tubing attached to either a 19-gauge or 16-gauge needle within a pressure cuff inflated to 400 mm Hg.
Results:
Median peak pressures were 35 lb/in.2 (psi)(range, 25 to 40 psi) and 27.5 psi (range, 15 to 40 psi) using a 35-mL syringe and a 65-mL syringe, respectively. Median peak pressures with the IV bag and plastic bottle were 4 psi (range, 2 to 5.5 psi) and 2.3 psi (range, 1.2 to 4.5 psi), respectively. The IV bag in a pressure cuff generated pressures of 6 to 10 psi and 4 to 6 psi using 19-gauge and 16-gauge needles, respectively.
Conclusion:
Both 35-mL and 65-mL syringes with a 19-gauge needle are effective in performing high-pressure irrigation in the range of 25 to 35 psi. The use of IV bags and plastic bottles should be discouraged when high-pressure irrigation is required.