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PubMed1991

Topical antibiotic irrigation in the prophylaxis of operative wound infections in orthopedic surgery.

1. Although the orthopedic literature on the clinical use of topical antibiotics is sparse, the effectiveness of topical antibiotics has been shown well enough in vitro and in the surgical literature to justify strong consideration of their use in orthopedic procedures. 2. Saline irrigation should not be relied upon to reduce bacterial contamination completely, although it does remove debris, foreign material, and clot, which often contain bacteria, from the surgical wound. 3. Topical antibiotic agents used for irrigation should have a broad spectrum of antimicrobial activity. Triple antibiotic solution (neomycin, polymyxin, and bacitracin) provides the most complete coverage against the organisms most likely to cause infections in both clean and contaminated orthopedic surgical cases. These agents should be allowed to remain in the wound for at least 1 minute before their removal. 4. Further studies of topical antibiotic irrigation in orthopedic surgery are needed to demonstrate the most effective antibiotic(s) and technique of administration. 5. There is evidence to suggest that the more often an irrigant is used, the more effective it is in preventing infection. 6. The use of bacitracin as an irrigant should probably be avoided in patients previously exposed to that agent. 7. Antibiotic-containing solutions should be utilized with pulsatile lavage systems. Saline alone may drive previously administered antibiotics from bone, leaving insufficient local antibiotic levels.

Administration, Topical↗

PubMed1990

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema thoracis is described. Initial thoracoscopy using a laparoscope under general anaesthesia enabled adequate debridement and breakdown of loculi within the empyema cavity under direct vision. Following this procedure irrigation of the cavity with two tubes was started and continued until three consecutive cultures of drained irrigation fluid became sterile. The procedure was then discontinued. The results in 14 patients are presented using this method, irrigation was required for an average of 14 days. Patients remained in hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contra-indication to the irrigation technique.

Adult↗

PubMed1989

[The value of irrigation].

Twenty percent of our patients who have had colostomy use irrigation to regulate the bowels. This decision is made by the patient himself after careful deliberation. By means of an irrigation set the large intestine is irrigated with approximately 1-1.5 l of water at body temperature. Subsequently there is a stool-free period of 24-28 h and a reduction of flatulence. The duration of irrigation is 45-60 min. Side effects are occasionally pressure sensation and mild convulsive symptoms, but there are no significant complications. Irrigation can begin after complete healing of the stoma, but is absolutely contraindicated in inflammatory intestinal diseases and relatively contraindicated in prolapse, hernia, stenosis, and intestinal damage by radiation.

Colostomy↗

PubMed1989

Prompt irrigation of chemical eye injuries may avert severe damage.

Chemical burns to the eye are among the most urgent of ocular emergencies. The clinical outcome of the injury is directly related to the expediency with which treatment is begun. Copious irrigation is the most important emergency treatment of the chemically-burned eye. This irrigation should begin immediately at the scene of the accident with any non-toxic liquid. Removal of any particulate matter must be done to prevent further ocular damage. The subsequent therapy is directed at the treatment of secondary sequelae and at preserving the globe to surgically rehabilitate the eye. Many of the treatments which are used in the intermediate and late phases of the injury are used to prevent corneal ulceration and perforation. These are the most difficult sequelae to threat in alkali injuries; thus, preventing the progression to this stage is of the utmost importance. Again the immediate and continuous irrigation of the eye may help accomplish this goal. The availability of emergency eye-wash equipment dispensing a safe, preserved, pH-balanced, physiologically correct solution in the industrial, agricultural and even the home setting is a necessity. The education of employees and family members in the proper technique of irrigating the eye following a chemical burn is also of extreme importance. Immediate irrigation of the eye, continued during rapid transport to a medical care facility, minimizes the damage to the eye and enhances the eventual clinical outcome.

Acids↗

PubMed1986

Post-prostatectomy auto-irrigation with furosemide in the tropics.

A progressive study was carried out in 49 patients who underwent prostatectomy (10 transurethrally and 39 transvesically) to assess the effects of furosemide given intravenously for post-operative bladder irrigation. All 10 transurethral patients and 17 of the transvesical patients received furosemide, the remaining 22 patients receiving formal external bladder irrigation with saline. The results showed that post-operative infection was lowest and bed stay shortest in the patients with furosemide auto-irrigation. There was also less need for blood transfusion. No significant changes in haemoglobin and packed cell volume were observed in the transurethral patients; however, both decreased significantly in all 39 patients with transvesical prostatectomy, whether or not furosemide was used. Auto-irrigation with furosemide was found to be associated with a significant post-operative decrease in serum potassium but not in serum sodium levels. When external irrigation with saline was used, there was a significant increase in serum sodium.

Aged↗

PubMed1986

Effect of irrigation or intravenous antibiotic prophylaxis on infectious morbidity at cesarean section.

The efficacy of intraoperative irrigation with cefamandole nafate at cesarean section was evaluated in a prospective, randomized double-blind study. Two hundred and eight patients were treated with antibiotic irrigation and intravenous placebo or with perioperative intravenous cefamandole and irrigated with normal saline. The rate of endometritis was 10.9% in the irrigation group and 14% in the intravenous group, but the difference was not statistically significant. The rate of any infection, the number of days with fever, additional hospitalization days, and number of antibiotics used for treatment were similar in the two groups. It thus was concluded that irrigation with antibiotic is equal but not superior to perioperative intravenous antibiotics.

Adult↗

PubMedDate not supplied

Surgical management of infected median sternotomy: closed irrigation vs. muscle flaps.

Mediastinitis remains a serious complication of median sternotomy which requires prompt and aggressive surgical management. Debridement and closed irrigation has been the conventional mode of treatment. Failure to respond results in open drainage and delayed healing with its associated increased morbidity and mortality. Secondary closure with rectus muscle flaps has been a marked advance in the treatment of these patients. In an attempt to define guidelines for the treatment of mediastinitis complicating median sternotomy, a retrospective review of 2,400 cardiac surgical cases at St. Vincent's Hospital from 1977 through 1982 was performed. There were 25 cases (1%) of mediastinitis. Debridement and closed irrigation was successful in 16 patients (64%) with an average postoperative hospital stay of 19 days. Failure resulted in open drainage in 2 patients (8%) with an average hospital stay of 66 days and debridement and secondary closure by rectus muscle flaps in 7 patients (28%) with an average hospital stay of 28 days. There were no deaths in the entire series. Failure to respond to closed irrigation was not due to delay in diagnosis. The length of time between operation and the first sign of sternal dehiscence did not vary significantly. Sternal dissolution, the presence of anaerobic organisms, large volumes of purulent and necrotic material, however, were responsible for continued mediastinitis and further sternal dehiscence. Open irrigation and delayed closure with muscle flaps should be reserved for these patients and appears to decrease significantly morbidity and length of hospital stay. Surgical debridement and closed irrigation, however, remains the primary method of treatment of the less virulent forms of mediastinitis following median sternotomy.

Debridement↗

PubMed1983

Whole bowel irrigation--an alternative to traditional bowel washout.

The objective of this study was to determine whether or not whole bowel irrigation through oral route was a safe and acceptable alternative to traditional bowel washout per rectum in preparation for large bowel surgery. Out of a total of 114 patients, 32 had whole bowel irrigation, 71 had traditional washout and 11 had no bowel preparation. The irrigation involved approximately 12 litres of normal saline over an average period of 3 1/4 hours. The preparation of the colon by whole bowel irrigation was better as indicated by total absence of faeces and the cleanliness of the colon at operation. However, there was no significant difference in wound infection rate between the two groups although the severity of wound infection was lesser in the first group. There were no major complications like anastomotic breakdown, burst abdomen, abscess or fistula formation and septicaemia in this group. Based on this experience we believe that whole bowel irrigation is a good alternative method of bowel preparation. The advantages of this method are that it is short and rapid, avoiding prolonged pre-operative hospitalisation and is acceptable to most patients.

Aged↗

PubMed1984

Intra-operative irrigation of the peritoneal cavity with ampicillin in experimental posttraumatic peritonitis.

Penetrating abdominal wounds with injury to the intestines were inflicted on 24 anaesthetized pigs. The injured gut was resected. During this operation the peritoneal cavity in 9 pigs was irrigated with 3 litres of antibiotic solution (ampicillin 2 g/l). In 15 pigs the irrigation was done with 3 litres of saline solution only. During the postoperative observation period the animals were in continuous anaesthesia. Absorption of ampicillin, reduction of the peritoneal bacterial flora and emergence of resistant strains were evaluated. Ampicillin was rapidly absorbed to the systemic circulation, with an average peak concentration of 42.4 +/- 1.7 mg/l. The average half-life of the drug in serum was 54 +/- 4 min. The average density of the total aerobic flora decreased during the operation from 10(4.74) CFU/ml peritoneal exudate fo 10(1.20) CFU/ml, but increased to 10(5.16) CFU/ml during the posttraumatic observation period. Total anaerobic counts changed to similar extent. The results were not significantly different from the values in the saline-irrigation group. Ampicillin irrigation led to a significant increase of resistant strains, from 25% before irrigation to 97% at the end of the observation period.

Abdominal Injuries↗

PubMed1981

Septic wound complications after whole bowel irrigation before colorectal operations.

Ninety-three patients for whom a colorectal operation was planned had their bowel prepared mechanically by orthograde irrigation. The tube was sited in the duodenum via the pylorus under X-ray and TV control. The procedure was discontinued in 2 patients (2%), 15 patients (16%) experienced nausea and vomiting, while 76 patients (82%) experienced no discomfort. The mean duration of the irrigation was 216 min (90-476 min) and the mean volume of fluid used 10.21 (5.0 -15.0 1). There were no significant differences between pre-irrigation and post-irrigation blood chemistry. Twenty-three patients developed postoperative abdominal wound sepsis (26.7%), 4 (4.7%) had an intraabdominal abscess; 9 out of 12 patients (75%) had perineal wound sepsis. Escherichia coli and Bacteroides were the dominant species cultured from colorectal mucosa during operation as well as from infected abdominal and perineal wounds. Although the irrigation technique seems to clean the bowel to a degree not previously seen, this in itself is no guarantee of avoiding post-operative wound sepsis after colorectal operations.

Adult↗

PubMed1980

[Results of periodic irrigation in rehabilitation of colostomy patients].

The Authors report their experience about 152 patients examined between 1976-1979 in the Aistom Centre of the Institute of "Semeiotica Chirurgica" at the University of Trieste. 98 patients irrigated their colostomies, while 57 patients were excluded in consequence of general or local counterindications. 92% of the irrigating patients gained fecal continence, but 1/4 of them use the colostomy bag to obtain full control of gas and odors. No cases of colonic perforation, bleeding or severe dermatitis were observed. The follow-up shows that most of the irrigating patients undergo less serious psychological problems and usually have easier social lives. It is opinion of the Authors that the results of colonic irrigation are better than natural evacuation. Irrigation should be therefore considered the best method of choice for the management of permanent colostomies.

Aged↗

PubMed1993

The use of intermittent chlorhexidine bladder irrigation in the prevention of post-prostatectomy infective complications.

The efficacy of peri-operative intermittent bladder irrigation with 0.05% chlorhexidine gluconate solution in the prevention of post-prostatectomy infective complications was assessed in men with pre-operative indwelling urinary catheters. Thirty-two consecutive patients undergoing transvesical prostatectomy were randomly allocated to the test group (chlorhexidine irrigation) and control group (saline irrigation). Pre-operatively, intermittent chlorhexidine bladder irrigation achieved sterile urine in only 3 of 13 patients, in the rest bacteriuria persisted. However, the irrigation was able to reduce significantly (P < 0.05) the incidence of intra-operative bacteraemia and severe wound infection. Furthermore, septicaemia was absent and post-operative urinary catheter requirements and hospital stay were shortened. Histology of bladder mucosal biopsies revealed that 0.05% chlorhexidine used on intermittent basis caused no injuries.

Aged↗

PubMed1994

[Hysteroscopy syndrome. Absorption of irrigation fluid in surgical hysteroscopy].

The availability of adequate endoscopic instruments has led to an increased interest in hysteroscopic surgical procedures. An electrolyte-free irrigation fluid is essential for the distention of the uterine cavity, with acceptable uterine distention occurring at 80-150 mmHg. The HSK syndrome, the intravascular absorption of a hypotonic irrigation fluid with subsequent hypotonic hyperhydration with hyponatremia, has to be considered as a risk during hysteroscopic procedures. Analogous to the TUR syndrome, intravasation occurs through the vascular spaces opened during large ablative surgical procedures resulting in the absorption of the fluid used for irrigation. Occasionally, a tear in the lower uterine segment from dilation or perforation of the uterus may expose large vascular channels. Outflow through the tubes is not a significant factor. Continuous CVP measurement allows the detection of intravascular absorption of the irrigation fluid and may be included in the routine monitoring for these procedures. The duration of the hysteroscopic procedure should be limited to 60 min. Addition of ethanol to the irrigating fluid may be suitable for early detection of fluid absorption. However, commercial solutions are not yet available.

Absorption↗

PubMed1975

Wound cleansing by high pressure irrigation.

All traumatic wounds are contaminated to some degree by both soil and bacteria. Specific infection potentiating factors in soil impair the defenses of the tissue and invite infection. These factors are small in size and resist removal by low pressure irrigation. The efficiency of wound irrigation is markedly improved by delivering the irrigant to the wound under continuous high pressure. Irrigation of the wound with saline solution delivered at 15 pounds per square inch removed 84.8 per cent of the soil infection potentiating factors from the wound. The residual infection potentiating factors remaining in the wound did not significantly impair tissue defenses. On the basis of these experimental studies, clinical studies are now being initiated to test the therapeutic value of high pressure irrigation in traumatic wounds in humans.

Animals↗

PubMed1993

[Culture of the irrigating fluid of the epidural space obtained during chronic epidural catheterization].

The most serious complication during long-term epidural catheterization is epidural infection. Bacterial culture of the irrigating fluid of epidural space was carried out periodically in 39 patients in whom epidural catheters were inserted for a long period of time. Eight (17%) of 47 samples of epidural irrigating fluid were contaminated by the normal skin flora. All of these cases were accompanied with epidural contamination by the same organisms. No significant correlation was found between clinical signs of infection (low grade fever, leucocytosis and localized infective signs at the puncture site) and the contamination of the epidural irrigating fluid or that of the epidural catheter. When epidural irrigating fluid was contaminated, the epidural catheter was removed immediately and the patient was treated by antibiotics. None of the patients had epidural abscess or neurological deficit. In conclusion, bacterial culture of epidural irrigating fluid is valuable for the early diagnosis of epidural infection during long-term epidural catheterization.

Adult↗

PubMed1993

[Safety of bladder irrigation and usefulness of BLADMAN for bladder training in the patients with spinal cord injury].

First, we used BLADMAN system for bladder irrigation on 47 outpatients with spinal cord injury. A syphon phenomenon of BLADMAN was applied to irrigation of the bladder. Irrigating liquid was a physiological saline solution and its volume was 500-1,000 ml. Bladder irrigation was done for 1 to 2 hours. As a result of bladder irrigation by this system, urine was clearer and the number of leucocyte in urine was decreased. There was no trouble and no side effects occurred while using this system. BLADMAN is safe and considered to be applicable to the patients with spinal cord injury. Secondly, we used BLADMAN for bladder training to the patients with spinal cord injury. Bladder training was done for 7 to 28 days on the patients with indwelling urethral catheter. The bladder function was compared before and after training. Bladder volume and compliance were significantly improved. There was no trouble while the patients used the BLADMAN system. We consider that the BLADMAN system is one of the best methods of bladder training for the patients with spinal cord injury.

Adolescent↗

PubMed1996

Histological changes in the nasal mucosa after hot-water irrigation. An animal experimental study.

Many years ago the treatment of posterior epistaxis was irrigation with hot water through the bleeding nose cavity, and the treatment was successful in many cases. The aim of this study is to explain how "hot-water irrigation" can cause haemostasis. Twenty-four rabbits were divided into 12 groups and their noses were irrigated for 5 min with hot water at temperatures ranging from 40-60 degrees C. After irrigation, the nose was fixed, sliced, stained, and evaluated blindly by a pathologist. The morphological changes-narrowing of intranasal lumen, vasodilation and stasis, extravasation of erythrocytes, and epithelial necrosis-were recorded. No changes were recorded after irrigation with water of 40-44 degrees C. Only light changes were present in the 46 degrees C group. Vasodilation occurred at a temperature of 48 degrees C or higher. From 48 degrees C, oedema of the mucosa and subsequent narrowing of the intranasal lumen was seen. Severe changes including epithelial necrosis, were found only in the groups treated with 52 degrees C or higher. The results of the study indicate that the haemostatic effect of hot water treatment for epistaxis may be caused by: (1) oedema and narrowing of the intranasal lumen, (2) vasodilation of the mucosal vessels, and (3) cleaning of the nose from blood coagulates.

Animals↗

PubMed1976

The phacoemulsification procedure. I. The effect of intraocular irrigating solutions on the corneal endothelium.

Irrigating solutions for intraocular purposes were evaluated for their possible damaging effects on the corneal endothelial cell structure and function. Rabbit corneal endothelium was perfused in vitro with Tis-u-Sol, Travenol Ringer's Solution, or Travenol Sodium Chloride. The irrigating solutions caused an immediate corneal swelling of 67 mum per hour +/- 5 (mean +/- standard error), which was not modified by a previous stabilization perfusion with glutathione-bicarbonate Ringer's (GBR). In contrast, the Plasma-lyte-148 solution which is used in the phacoemulsification procedure, did not cause corneal swelling for more than twenty minutes, and for more than sixty minutes if the cornea was perfused after a GBR stabilization. After more than sixty minutes of corneal swelling, endothelial intercellular junction separations appeared. This breakdown was present with the tested irrigating solutions except for Travenol Ringer's Solution, which contained calcium. Plasma-lyte was also evaluated in conjunction with the surgical phacoemulsification procedure. The complete procedure or just irrigation with ultrasound did not cause endothelial cell damage similar to a prolonged in vitro irrigation. Instead, endothelial cells were traumatically damaged in varying degrees by the surgical manipulations.

Animals↗