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PubMed1993

Simplified infusion method for 10% hemiacidrin irrigation of renal pelvis.

A variable pressure volumetric pump was used for 10% hemiacidrin irrigation of the renal pelvis in 7 renal units (6 patients) with struvite calculi after initial percutaneous debulking and extracorporeal shock-wave lithotripsy (ESWL). The pump provided a constant display of intrapelvic infusion pressure, and an alarm which signaled if a preset maximum infusion pressure was exceeded. Compared with standard open manometer monitoring of intrapelvic pressure, this closed system of irrigation eliminates the problems associated with time-consuming assembly and maintenance, irrigant spillage, and system contamination. At the completion of therapy, 5 renal units were completely stone-free while 2 had only minimal residual caliceal "dust." Complications were minor and few in number. We conclude that a variable pressure volumetric pump provides excellent clinical results and safely simplifies irrigation for percutaneous chemolysis of struvite calculi.

Citrates↗
PubMed1994

Continuous versus intermittent flow irrigation in transurethral resection of the prostate.

OBJECTIVE: We compared fluid absorption, blood loss, and immediate postoperative complications in transurethral resection of the prostate (TURP) performed with the continuous flow and the intermittent flow irrigation techniques. We also studied pressure conditions under which fluid absorption occurs when continuous flow irrigation is used. METHODS: One experienced urologic surgeon performed TURP in 40 patients using suprapubic drainage of the bladder and in 40 other patients using the intermittent-filling technique. Fluid absorption was measured by the ethanol method every ten minutes. The intravesical pressure was recorded continuously in 23 of the patients with suprapubic drainage. RESULTS: Fluid absorption was more common when suprapubic drainage was used (P < 0.004). There were no differences in operating time, blood loss, postoperative complications, or in the period of hospitalization. Low-degree absorption occurred during minor elevations of the intravesical pressure, and massive fluid absorption was associated with pressures between 1.0 and 2.5 kPa (10 and 25 cm H2O). CONCLUSIONS: Continuous flow irrigation promoted fluid absorption, which occurred at lower pressures than commonly believed. With respect to other parameters, we found no superiority of one irrigating technique over the other.

Absorption↗
PubMed1991

Clinical comparison of ocular irrigation fluids following chemical injury.

This study tested the hypothesis that four ocular irrigating solutions were equally irritating during copious irrigation. We conducted a prospective, double-blind study of patients with chemical exposure to the eye. Each underwent cross-over irrigation with all of the following in random order: normal saline (NS), lactated Ringer's (LR), normal saline adjusted to pH 7.4 with sodium bicarbonate (NS + Bicarb), and Balanced Saline Solution Plus (BSS Plus, Alcon Laboratories, Fort Worth, TX). Compared with traditional NS and LR, NS + Bicarb tended to be more comfortable. BSS Plus was statistically superior (P less than .05) to NS and preferred over LR and NS + Bicarb. Three patients demanded discontinuance of NS or NS + Bicarb infusions. All solutions had comparable normalization of conjunctival pH and degree of injection. Alternate solutions including BSS Plus should be considered for use in those patients whose poor tolerance to normal saline threatens to delay or interrupt eye irrigation following a chemical injury.

Bicarbonates↗
PubMed2005

Irrigated radiofrequency ablation with transmurality feedback reliably produces Cox maze lesions in vivo.

BACKGROUND: Irrigated bipolar radiofrequency ablation has been used to replicate Cox maze surgical scars in pig hearts ex vivo. Impedance monitoring accurately predicted complete transmurality for all lesions. This study aimed to assess the feasibility and reliability of irrigated radiofrequency ablation and impedance monitoring to produce electrically isolating Cox maze lesions in vivo. METHODS: A modified Cox maze procedure was performed in 8 adult sheep during cardiopulmonary bypass using irrigated bipolar and unipolar radiofrequency ablation. For bipolar radiofrequency ablation, atrial tissues were clamped between opposing electrodes; ablation was terminated at the plateau in impedance decline. Unipolar radiofrequency ablation lesions were painted on the endocardium, and transmurality was assessed visually. Animals survived 30 days. RESULTS: Bipolar lesions (n = 48) were thinner (7.4 +/- 2.4 mm versus 12.7 +/- 3.2 mm) and required less time (14.1 +/- 3.4 seconds versus 41.4 +/- 21.8 seconds) and energy (377.5 +/- 99.2 W.s versus 995.1 +/- 547.1 W.s) to create despite being longer (31.7 +/- 8.6 mm versus 19.2 +/- 5.6 mm) than unipolar lesions (n = 26). The left atrial pacing threshold across selected bipolar lesions increased at least fivefold above baseline (1.6 +/- 0.2 mA) at 1 hour (18.4 +/- 4.6 mA; n = 8; p < 0.001) and 30 days (17.2 +/- 5.2 mA; n = 6; p < 0.001), indicating functional conduction block. Bipolar lesions had no adherent thrombus or endocardial defects. Cross-section examination confirmed transmurality in 100% of bipolar lesions and 98.7% of unipolar lesions. CONCLUSIONS: Irrigated bipolar radiofrequency ablation with impedance monitoring safely and reliably produces electrically isolating, transmural Cox maze lesions in vivo.

Animals↗
PubMed2004

Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease.

OBJECTIVES: The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND: In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow. METHODS: Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool). RESULTS: Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 +/- 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 +/- 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 +/- 11) and mean power was lower (27 +/- 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 +/- 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation. CONCLUSIONS: The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.

Adolescent↗
PubMed2006

Saline irrigation and wound infection in abdominal gynecologic surgery.

OBJECTIVE: To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery. METHOD: In this prospective randomized study, 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not. RESULTS: There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery. The incidence of wound infection was 10.6% among women who underwent wound irrigation and 9.8% among those who did not, and the difference was not statistically significant. CONCLUSION: Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.

Adult↗
PubMed2004

Anterior chamber irrigation with an ozonated solution as prophylaxis against infectious endophthalmitis.

PURPOSE: To assess the validity of anterior chamber irrigation with an ozonated solution as prophylaxis against endophthalmitis. SETTING: Department of Ophthalmology, Nippon Medical School, Tokyo, Japan. METHODS: Viability of human corneal endothelium in culture was assessed by the WST-8 assay, lactate dehydrogenase (LDH) release assay, and trypan blue exclusion assay after exposure to a 4 to 40 parts per million (ppm) solution for 10 to 60 seconds. The in vivo effect was observed 1 week after irrigation of a 4 ppm solution in the rabbit anterior chamber by trypan blue exclusion assay. Bactericidal efficacy of the anterior chamber irrigation with the 4 ppm solution was examined by bacterial colony count of the aqueous humor following methicillin-resistant Staphylococcus aureus (MRSA) contaminated intraocular lens implantation in the porcine eye. RESULTS: The WST-8 assay revealed no significant reduction of viability with 10-second exposure to a 4 ppm solution. Lactate dehydrogenase release and trypan blue exclusion assays similarly demonstrated little damage after 60-second exposure to a 4 ppm solution. In the rabbit cornea 1 week after treatment, damage caused by 30-second exposure to a 4 ppm solution was not significant. The MRSA colony count documented almost complete bactericidal action with 5-second exposure to the 4 ppm solution when no ophthalmic viscosurgical device existed in the anterior chamber. CONCLUSION: Limited damage to the corneal endothelium after 10-second exposure and potent bactericidal action with 5-second exposure suggests the validity of anterior chamber irrigation with a 4 ppm ozonated solution as prophylaxis against endophthalmitis.

Animals↗
PubMed2006

Reduction in antimicrobial substantivity of MTAD after initial sodium hypochlorite irrigation.

Potential intrinsic tetracycline staining of intraradicular dentin has been observed when BioPure MTAD was employed as the final irrigant after initial rinsing with NaOCl. This study examined the effect of NaOCl-MTAD interaction on the antimicrobial substantivity of MTAD in dentin. Dentin cores previously irrigated with either MTAD, or in conjunction with 1.3% NaOCl as an initial irrigant were placed on blood agar plates inoculated with Escherichia faecalis at 10(5) cfu/ml. Dentin cores irrigated with 1.3% NaOCl only, and autoclaved dentin disks were used as the respective positive and negative controls. After anaerobic incubation, the mean diameter of bacterial inhibition zones formed around the MTAD group was significantly larger than the NaOCl/MTAD group, which, in turn, was not significantly different from the NaOCl positive control. Oxidation of MTAD by NaOCl resulted in the partial loss of antimicrobial substantivity in a manner similar to the peroxidation of tetracycline by reactive oxygen species.

Anti-Bacterial Agents↗
PubMed2006

Efficacy of a new brush-covered irrigation needle in removing root canal debris: a scanning electron microscopic study.

The usefulness of NaviTip FX, a brush-covered irrigation needle, in endodontic therapy has never been reported. Therefore, the purpose of this investigation was to evaluate the cleaning efficacy of this new brush-covered irrigation needle, the NaviTip FX. Thirty single-rooted teeth were randomly divided into two equal groups and instrumented using the crown-down technique with 0.04 taper ProFile. Following each file use, the canals were irrigated with 1 ml of 5.25% NaOCl using the NaviTip FX needle for group 1 or using the same needle without the brush for group 2. At the end of instrumentation, the roots were cut longitudinally and each half was divided into three equal parts. The specimens were then routinely prepared for scanning electron microscopic evaluation. The results showed that using the NaviTip FX produced cleaner coronal thirds of instrumented root canals compared to the control group. On the other hand, the middle and apical thirds were not statistically significantly different between the two groups. Further development of this irrigation technique to improve cleanliness of the apical and middle thirds is required before the NaviTip FX can be recommended for routine use during root canal therapy.

Dental Equipment↗
PubMed2007

Comparison of the antimicrobial efficacy of 1.3% NaOCl/BioPure MTAD to 5.25% NaOCl/15% EDTA for root canal irrigation.

The purpose of this study was to compare the antimicrobial efficacy of 1.3% NaOCl/BioPure MTAD to 5.25% NaOCl/15% EDTA for root canal irrigation. Twenty-six bilaterally matched pairs of human teeth were collected. The teeth were incubated with Enterococcus faecalis for 4 weeks. The teeth were divided into two experimental groups and one positive control group. The canals were instrumented and irrigated with either 5.25% NaOCl/15% EDTA or 1.3% NaOCl/BioPure MTAD. Bacterial samples were collected after instrumentation/irrigation and after additional canal enlargement. Statistical analysis of the data using the Wilcoxon Signed Rank test showed significant differences between the experimental groups. The first bacterial samples revealed growth in 0 of 20 samples with 5.25% NaOCl/15% EDTA irrigation and in 8 of 20 samples with 1.3% NaOCl/BioPure MTAD irrigation. Samples taken after additional canal enlargement revealed growth in 0 of 20 samples in 5.25% NaOCl/15% EDTA and in 10 of 20 samples in 1.3% NaOCl/BioPure MTAD group. This investigation showed consistent disinfection of infected root canals with 5.25% NaOCl/15% EDTA. The combination of 1.3% NaOCl/BioPure MTAD left nearly 50% of the canals contaminated with E. faecalis.

Anti-Infective Agents↗
PubMed2006

Various irrigation fluids affect postoperative brain edema and cellular damage during experimental neurosurgery in rats.

BACKGROUND: This study was conducted to investigate how various irrigation fluids used during neurosurgical procedures affect the degree of postoperative brain edema and cellular damage during experimental neurosurgery in rats. METHODS: The cerebral cortex was exposed and incised crosswise with a surgical knife under irrigation with an artificial CSF, lactated Ringer's solution, or normal saline. Four hours after injury, irrigation was stopped and brain tissue samples were obtained from injured and uninjured sites. Specific gravity, cerebrovascular permeability, and TTC staining of the samples were evaluated. Incision and irrigation of the brain were not performed on the control group. RESULTS: At the injured site, specific gravities of the samples in the normal saline group and the lactated Ringer's solution group were significantly lower than the specific gravity in the artificial CSF group. The EB concentration was significantly higher in the lactated Ringer's solution group and relatively high in the normal saline group as compared with the artificial CSF group. TTC staining did not differ significantly between the artificial CSF group and the control group. It was significantly lower in the lactated Ringer's solution group and the normal saline group than in the control group and the artificial CSF group. CONCLUSIONS: As compared with normal saline and lactated Ringer's solution, artificial CSF reduced postoperative brain edema, cerebrovascular permeability, and cellular damage in sites injured by experimental neurosurgery in rats.

Animals↗
PubMed2004

Comparative study of intra-articular irrigation and corticosteroid injection versus closed reduction with intermaxillary fixation for the management of mandibular condyle fractures.

OBJECTIVE: To evaluate the clinical outcome of a modified conservative treatment protocol involving intra-articular irrigation and corticosteroid injection into the superior joint compartment (SJC) of patients with fresh mandibular condyle fractures. Study design A total of 26 consecutive unilateral fresh condylar fractures in 26 patients were divided into the intra-articular irrigation (IR) group (14 patients, 14 joints) and the conventional conservative treatment (CC) group (12 patients, 12 joints). In the IR group, the SJCs of the fractured joints were irrigated with saline solution and injected dexamethazone sodium, followed by conventional rehabilitation. In the CC group, patients were treated by closed reduction with intermaxillary fixation (IMF) for 2 weeks, followed by conventional rehabilitation. Clinical outcome at 1 month, 3 months, 6 months, and 1 year after injury was determined by clinical examination of jaw motion, joint pain, and occlusal changes. The posttreatment results were compared with the pretreatment baseline data. Between-group differences in clinical parameters were analyzed. RESULTS: There were significant between-group differences in the range of mandibular motion at 1 month and 3 months after injury (1 month, P=.0022; 3 months, P=.0022). In the IR group, joint pain was well relieved from the early stage of treatment. Occlusal changes were found in 1 patient in the IR group and 4 patients in the CC group at 1 year after injury. CONCLUSIONS: The modified treatment protocol involving intra-articular irrigation and corticosteroid injection into the SJC is a more effective and quick-acting modality than conventional closed reduction with IMF for functional recovery and control of clinical symptoms of patients with unilateral fresh condylar fractures.

Adult↗
PubMed2004

A novel dual-diameter ureteroscope working channel: impact on irrigant flow.

OBJECTIVES: To compare irrigant flow characteristics through standard working channels (3.6F to 4.5F) and a dual-diameter working channel. Irrigant flow is critical for adequate visualization during endoscopic procedures. METHODS: Working channels were created out of 80 cm of light wall polytetrafluoroethylene (PTFE) tubing (inner diameter 3.6F, 4.0F, and 4.5F) with a male Luer connector attached to one end by epoxy resin. The dual-diameter working channel was created with a 70-cm segment of PTFE (4.5F inner diameter, 0.059 in.) and a 10-cm segment of PTFE (3.6F inner diameter, 0.047 in.) with a male Luer connector attached to the free end of the 4.5F tubing. Stone basket shafts (100 cm in length, outer diameter 1.9F, 2.4F, and 3.0F) were created out of unmodified polyimide tubing with a 0.018-in.-diameter nitinol mandrel epoxy core for stability. Irrigant flow was measured at 100 mm Hg pressure for 1 minute with an empty channel and with stone basket shafts in the channel. RESULTS: The flow rates were significantly greater with the dual-diameter working channel than with the standard flexible ureteroscope (3.6F) working channel using an empty channel (79.2 versus 44.1 mL/min, P = 0.0001), 1.9F basket (35.9 versus 10.0 mL/min, P = 0.003), 2.4F basket (20.7 versus 4.3 mL/min, P = 0.002), and 3.0F basket (6.0 versus 0.7 mL/min, P = 0.0002) sheath. CONCLUSIONS: A dual-diameter working channel may optimize irrigant flow characteristics for flexible ureteroscopes while maintaining a small distal tip diameter.

Polytetrafluoroethylene↗
PubMed2006

Use of expired breath ethanol measurements in evaluation of irrigant absorption during high-power potassium titanyl phosphate laser vaporization of prostate.

OBJECTIVES: To evaluate formally the risk and levels of irrigant absorption during high-power potassium titanyl phosphate (KTP) laser vaporization of the prostate by the Greenlight PV system using the expired breath ethanol technique. METHODS: Forty consecutive patients underwent laser vaporization of the prostate. Of these patients, 17 had a preoperative transrectal ultrasound estimation of the prostate volume (mean 97 cm3). All procedures were performed under general anesthesia, by either of two consultants or a trainee. A 1% ethanol solution was used as irrigation fluid. Throughout the operation, the expired breath was analyzed for ethanol using a standard alcometer "plumbed" into the anesthetic circuit. Venous blood samples were taken immediately before and after the procedure for measurements of serum sodium and plasma alcohol levels. RESULTS: On average, 155,000 J of laser energy was delivered in 47 minutes. In all patients and on all occasions, the expired breath ethanol remained at 0. No statistically significant change was found in the serum sodium concentration during the procedure (P = 0.42), and no patient displayed any clinical evidence of transurethral resection syndrome. CONCLUSIONS: The results of this study have confirmed, for the first time, the lack of significant absorption of irrigation fluid during high-power KTP vaporization of the prostate using a recognized sensitive technique and the safety of using sterile water as that irrigant. This was the case even in those patients with very large prostates who are usually considered at high risk of experiencing the clinical consequences of fluid absorption during transurethral resection of the prostate and regardless of the experience of the surgeon.

Absorption↗
PubMed1981

A method of early irrigation of the contaminated postpneumonectomy space.

A modified balanced drainage system was used with other measures in a patient with an obstructing pulmonary carcinoma, infection, and necrosis. Management included right pneumonectomy, perioperative systemic antibiotics, protection of the remaining lung, and a modified balanced drainage system that allowed early irrigation of the postpneumonectomy space. On the tenth postoperative day, irrigations were discontinued, the right chest was filled with an antibiotic solution, and the thoracostomy tubes were removed. The mediastinum remained in a satisfactory position, and the patient recovered without evidence of empyema. He died of a cerebral metastasis five and a half months postoperatively. This method combines principles that have been used for many years. A balanced drainage-irrigation system permits early irrigation of the contaminated postpneumonectomy space while the mediastinum is still mobile. Prolonged hospitalization and formal closure of the thoracostomy sites can be avoided.

Anti-Bacterial Agents↗
PubMedDate not supplied

Per-rectal pulsed irrigation versus per-oral colonic lavage for colonoscopy preparation: a randomized, controlled trial.

The aim of this study was to compare the efficacy and patient tolerance of a new pulsed irrigation system to colonic lavage for colonoscopic preparation. Thirty-four prospective patients scheduled for routine colonoscopy were randomized to one of two preparations: a per-rectal pulsed irrigation device (18 patients) versus per-oral colonic lavage (15 patients). Colonoscopic preparation was assessed on a 0 to 4 plus scale by region and overall. This was done live and by video tape by two independent endoscopists who were blinded to the patient's preparation. There was no significant difference with respect to cleanliness of the colon with pulsed irrigation patients having an average overall preparation score of 3.00 +/- 0.19 (SEM) versus colonic lavage patients with a score of 3.14 +/- 0.19. There was also no statistically significant difference between the two groups with respect to demographics, time to reach the cecum, time for entire procedure, volume of aspiration or wash, or sedation given. We conclude that the new pulsed irrigation device provides an alternative to the standard per-oral lavage solution for colonoscopic preparation.

Administration, Oral↗
PubMed1982

Whole bowel irrigation in pediatric patients.

Whole bowel irrigation was used in 24 patients ages 8 to 17 yr, mean 13 yr, in preparation for colonoscopy (18), colon surgery (2), therapeutic irrigation for treatment of drug overdose (2), and constipation (2). An average of 9 liters warm, normal saline with added KCL (5 mEq/liter) was infused through a nasogastric tube over a period of 7 +/- 2 hr (mean +/- SD). This resulted in a weight gain of 2% and a mild hyperchloremia. The vital signs remained stable and there were no complications. The colonic preparation was complete in 10, adequate in 8 and unsatisfactory in 2. The irrigation was effective in the treatment of overdose ingestion and constipation. It is concluded that whole bowel irrigation is a satisfactory method of colonic preparation of pediatric patients.

Adolescent↗
PubMed1998

Pleural space irrigation and modified Clagett procedure for the treatment of early postpneumonectomy empyema.

OBJECTIVE: The incidence of postpneumonectomy empyema is 5% to 10%. Approximately half of postpneumonectomy empyemas occur within 4 weeks of pneumonectomy. A bronchopleural fistula is found in more than 80% of the patients. The classic treatment of postpneumonectomy empyema includes parenteral antibiotics, drainage of the pleural space, removal of necrotic tissue, and open pleural packing for many weeks followed by obliteration of the empyema space with antibiotic fluid or muscle. This approach results in prolonged hospitalization, repeated operations, and significant morbidity. As a possible means of decreasing morbidity with the classic treatment of postpneumonectomy empyema, we studied the use of pleural space irrigation in these patients. METHOD: In a 5-year period, we treated 22 patients with early postpneumonectomy empyema. All patients had a bronchopleural fistula. All patients underwent emergency drainage of the pleural space followed by thoracotomy, debridement of necrotic tissue, closure of the bronchial stump with absorbable monofilament suture, and pleural space irrigation. After a negative Gram stain from the pleural fluid, the pleural space was filled with 2 L of debridement antibiotic solution (DAB solution) (gentamicin 80 mg/L, neomycin 500 mg/L, and polymyxin B 100 mg/L), and the irrigation and drainage catheters were removed. RESULTS: Twenty patients had negative Gram stains on day 9, and 2 patients had a negative Gram stain on day 16. The mean duration of hospitalization was 12.9 +/- 3. 4 days. There was no recurrence of empyema or a bronchopleural fistula. CONCLUSIONS: Pleural space irrigation followed by obliteration of the pleural space with an antibiotic solution required one surgical procedure and resulted in significantly shorter hospitalization and decreased morbidity in patients with early postpneumonectomy empyema.

Anti-Bacterial Agents↗