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PubMed1989

Once-daily irrigation of long-term urethral catheters with normal saline. Lack of benefit.

Urinary incontinence is often managed with a long-term urethral catheter after other methods have failed. Such urethral catheterization is associated with polymicrobial bacteriuria, catheter obstruction, fever, bacteremia, urinary tract stones, and death. Periodic catheter irrigation is a common but untested management procedure intended to prevent catheter obstruction, fevers, and/or bacteremia. To evaluate this technique, we performed a randomized crossover trial comparing ten weeks of once-daily normal saline irrigation with ten weeks of no irrigation in 32 long-term catheterized women. The incidence of catheter obstructions and febrile episodes and the prevalence and species of bacteriuria were similar whether examined as completed crossover patients (N = 23) or as partially completed trials (N = 9). Once-daily irrigation with normal saline of long-term urethral catheters is a time-consuming and costly procedure that is unlikely to have an impact on the morbidity associated with such catheters.

Adult↗

PubMed1986

Treatment of septic olecranon and prepatellar bursitis with percutaneous placement of a suction-irrigation system. A report of 12 cases.

Ten cases of septic olecranon bursitis and two cases of septic prepatellar bursitis were treated in the period from 1975 to 1980 with antibiotics and percutaneous tube placement for suction-drainage and local antibiotic irrigation. All patients had positive bacterial cultures: Staphylococcus aureus in nine, beta-hemolytic Streptococcus in two, and Staphylococcus epidermidis in one. Intravenous antibiotics, local suction-drainage, and irrigation with a solution of 1% kanamycin and 0.1% polymyxin controlled the infection in each case. The antibiotic treatment averaged 19 days, compared with 24 days in a series in which suction-irrigation was not used. In contrast with studies in which aspiration or incision and drainage were performed, there were no complications or recurrences. Percutaneous suction-irrigation appears to be a safe, effective method of treatment that is particularly beneficial in severe cases of septic bursitis in which continuous drainage is desirable.

Adult↗

PubMedDate not supplied

Effect of feeding tube properties and three irrigants on clogging rates.

An experimental study was conducted on 3 consecutive 12-hour days to determine if selected physical properties of feeding tubes (material and diameter) affect tube clogging. Effectiveness of three irrigant fluids (cranberry juice, Coca-Cola, and water) in preventing tube clogging was studied. One hundred eight tubes were connected to gravity flow feeding bags containing isotonic enteral formula; 54 polyurethane and 54 silicone tubes were equally divided as to external diameters of 8 French (Fr), 10 Fr, and 12 Fr. At 4-hour intervals, flow regulators on the feeding bags were adjusted to a rate of 50 ml/hour. Fluid volumes delivered per minute were measured for each tube at 2-hour intervals. One set of tubes at each station was irrigated periodically with cranberry juice, Coca-Cola, or water. On each of the 3 days, analyses revealed significant, p less than .05, effects for tube material, cranberry juice contrasted with Coca-Cola and water as irrigants, and time. Polyurethane was consistently superior to silicone as a tube material, and cranberry juice was consistently inferior to both Coca-Cola and water as an irrigant. Tube diameter had no significant effect on the incidence of tube clogging.

Beverages↗

PubMed1988

The role of Picolax before whole gut irrigation in the preparation of the colon for large bowel surgery.

Whole gut irrigation is easier for the patient and more likely to be successful if the colon is prepared before irrigation. This study compared Picolax, given the day before irrigation, with an enema regimen and showed that there was no difference in the volume of fluid required and the time taken for whole gut irrigation to produce a clear effluent between the two groups.

Cathartics↗

PubMed1987

Whole bowel irrigation as a decontamination procedure after acute drug overdose.

Whole bowel irrigation, routinely used before colonoscopy, is evaluated as a potential gastrointestinal decontamination procedure for acute drug overdose. Nine adult volunteers, who served as their own controls, each ingested 5.0 g of ampicillin trihydrate on two occasions, one week apart. Whole bowel irrigation with polyethylene glycol electrolyte lavage solution was performed one hour after one ingestion. Serial serum ampicillin levels, electrolytes, osmolalities, body weights, and hematocrits were obtained. The areas under the concentration vs time curves for ampicillin were computed for both groups, and their means were compared. Mean duration of the procedure was 234 minutes and mean volume of infused polyethylene glycol electrolyte lavage solution was 7.7 L. Whole bowel irrigation produced a 67% decrease in ampicillin absorption and there were no significant changes in body weight, hematocrit, serum electrolytes, or osmolality. We conclude that whole bowel irrigation is an effective and safe gastrointestinal decontamination procedure for acute drug ingestion.

Adult↗

PubMed1987

Poststernotomy mediastinitis treated by omental transfer without postoperative irrigation or drainage.

Mediastinitis is an infrequent but life-threatening complication after cardiac operations. We reviewed our experience in treating eight select patients in whom this complication developed. Diffuse mediastinitis was verified at operation, and all patients were treated with the same surgical procedure by the same surgeon. The technique consisted of sternal bone débridement, mediastinal fat and connective tissue excision, pericardiectomy, and transfer of the greater omentum into the mediastinum on a vascular pedicle for obliteration of dead space. The sternum and sternal fascia were closed completely and the skin was closed loosely in each case. Postoperative drainage was not provided and postoperative irrigation was not performed. The mortality rate was 12.5% and the hospital stay averaged 27 days, comparable to other series in which irrigation has been used. We conclude from this review that the approach of omental transfer provides an alternative to prolonged irrigation and drainage of the mediastinum in the surgical management of these critically ill patients. This is neither a radical nor a disfiguring procedure, but is simple and easily done by the cardiac surgeon. Early ambulation, because of a lack of cumbersome irrigation and drainage apparatus, results in improved pulmonary function. Dead space is obliterated with tissue that has demonstrable ability to resist infection. Also, loose closure of the skin allows for primary healing with a good cosmetic result.

Drainage↗

PubMed1979

Intraperitoneal irrigation with povidone-iodine solution for the prevention of intra-abdominal abscesses in the bacterially contaminated abdomen.

A prospective randomized investigation was undertaken, involving 168 consecutive patients undergoing laparotomy for conditions accompanying bacterially contaminated peritoneal cavities, to evaluate the effectiveness of povidone-iodine irrigation of the peritoneum in preventing the development of intra-abdominal abscesses. In the treatment group irrigated with povidone-iodine solution, 0.1 per cent available iodine, one of 80 patients had an abscess, 1.3 per cent, while, in the saline solution irrigated control group, nine of 88 patients had abscesses, 10.2 per cent, p less than 0.05. Although the serum iodine levels were elevated 24 hours after intraperitoneal irrigation with povidone-iodine solution, iodine levels returned to near normal by 72 hours. Thyroxine levels showed no major changes. No complications resulting from the use of povidone-iodine were recognized.

Abscess↗

PubMed1986

Transesophageal irrigation for the treatment of mediastinitis produced by esophageal rupture.

Esophageal rupture in the thorax, unless small and contained, is followed by the early onset of fulminant mediastinitis. When the rupture occurs in the cervical esophagus, mediastinitis will also occur if cervical drainage is delayed and the infection is allowed to spread along the periesophageal planes towards the mediastinum. The purpose of this article is to report the good results obtained in the treatment of life-threatening sepsis from esophageal rupture with the combination of continuous per oral transesophageal irrigation of the mediastinum and drainage of the irrigating fluid by accurately positioned chest tubes connected to a wall-suctioning system. When the patient cannot swallow, mediastinal irrigation is accomplished via a nasogastric tube positioned by the upper esophagus proximal to the perforation. Irrigation by mouth was also used for the treatment of cervical perforations with the drainage tubes positioned in the neck. With this method in eight patients, sepsis has invariably been controlled, and in six cases, in which no irreversible damage to the esophagus existed, the perforations have healed spontaneously. There was no death resulting from mediastinitis, which is most often the lethal factor in esophageal rupture.

Esophageal Diseases↗

PubMed1979

Irrigation of subcutaneous tissue with povidone-iodine solution for prevention of surgical wound infections.

Five hundred patients undergoing a variety of general surgical operative procedures were prospectively randomly allocated into a treatment group, in which the incisions were irrigated with povidone-iodine solution prior to skin closure or into a control group in which wounds were irrigated with saline solution. Wounds were classified according to the degree of bacterial contamination as clean, potentially contaminated, contaminated or dirty. For all categories of surgical incisions, povidone-iodine irrigation resulted in a significant decrease in wound infections over that for saline solution irrigation. Over-all incidence of wound sepsis in the treatment group was seven of 242 patients, 2.9 per cent, compared with the control rate of 39 wound infections of 258 patients, 15.1 per cent--p less than 0.001.

Adolescent↗

PubMed1979

[Whole gut irrigation for cleansing the bowel (author's transl)].

Whole gut irrigation with an isotonic electrolyte solution is said to be an effective, easily and rapidly performed cleansing preparation for colonoscopy. We studied the effect of this method upon water and electrolyte metabolism and on intestinal transit. 35 patients were prepared for colonoscopy by whole gut irrigation via a gastric or duodenal tube. We observed a weight gain of 1.8 +/- 0.3 kg (mean +/- SD) and an increase in serum sodium and chloride. These changes were almost completely reversible within 24 hours. During the irrigation the intestinal transit time shortened by about 50%. The results demonstrate that whole gut irrigation has only slight side effects, but caution is warranted in patients with disturbed tolerance of sodium and water.

Adult↗

PubMed1981

[Use of a long term irrigation resectoscope (Iglesias) in the transurethral resection (TUR) of the bladder neck adenoma].

The initial euphoria which was given to the permanent irrigation resectoscope yielded a sober way of consideration. In a critical estimation of the new instrument, in our opinion, the 10 advantages, which iglesias emphasizes with regard to this device, may be reduced to three: 1. Shortening of the operation time or prolongation of the "pure resection time". 2. Better conditions of sight, which are particularly of importance for teaching clinics. 3. Reduction of the hydrodynamic and hydrostatic pressure and thus avoidance of the transurethral resection syndrome. The obstruction of the drainage slits particularly in more severe haemorrhages proved as a disadvantage, a problem which certainly could be solved by a technical improvement. With increasing experience in handling of the permanent irrigation resectoscopes the danger of the underestimation of a haemorrhage by the continuous irrigation stream is reduced. In our opinion the permanent irrigation resectoscope brings an enrichment for the transurethral technique is finally for the benefit of our patients.

Adenoma↗

PubMed1984

Prevention of irrigating fluid absorption during transurethral resection of the prostate.

This thesis contains studies on the prerequisites for fluid absorption during transurethral resection of the prostate (TURP) and suggestions on its prevention. The pressure gradient bladder-prostatic fossa to pelvic veins and its relation to fluid absorption were studied in patients using a sensitive detection technique with a radionuclide. It is concluded that to prevent fluid entering the vascular system, the bladder pressure should be kept below the pressure in the pelvic veins. The physical properties of the irrigating jet of resectoscopes were investigated in model experiments including an artificial, "bleeding" prostatic fossa. The dynamic pressure of the jet amounts to only 1-3% of the driving head and thus is of marginal importance in fluid absorption. The effect of various flow rates on the optical field was also demonstrated. In patients with prostatism epidural and spinal analgesia increased the bladder capacity but always with a corresponding increase in bladder pressure. In a preliminary study a correlation was found between the minimum urethral resistance and the compliance of the detrusor during epidural analgesia. This may suggest a relation between prostatic obstruction and changes of the viscoelastic properties of the bladder wall. The effects of various irrigating flow rates on the pressure-volume response of the bladder and its relation to the pressure in the pelvic veins was also investigated. From this study it was concluded that the detrusor response was unaffected by flow rates used during TURP. The critical bladder pressure above which fluid is absorbed changed with the position of the patient. In the Trendelenburg (20 degrees) position it was 0.25 kPa (approximately equal to 2.5 cmH2O), increasing to 1.25 kPa in the horizontal and 1.75 kPa in the half-sitting (20 degrees) position. To prevent absorption bladder pressure must be monitored. A simple pressure warning device with an adjustable warning level and which can be combined with any irrigating technique is presented. Irrigation with a large driving head may thus be combined with a low pressure resection.

Absorption↗

PubMed1984

Preparation and sterilization by filtration of Renacidin irrigation.

A method for the sterilizing filtration of Renacidin, a urologic irrigating solution, was evaluated. Renacidin irrigation was prepared and sterilized by microporous membrane filtration. A sterilizing membrane filtration apparatus was challenged by inoculating a batch of irrigation solution with Escherichia coli. The sterility of both intentionally contaminated and routinely prepared batches was evaluated. The stability of the solution was monitored by pH measurement, visual examination, maintenance of a vacuum, and absorbance spectrum of a 1:100 dilution in deionized water over a wavelength range from 400 to 200 nm. The time required to prepare three one-liter units was about two hours. No microbial growth was detected in any of the samples. The predicted minimum shelf-life at 10 degrees C was six months. Because the prepared solution contains some unreacted citric acid and bicarbonates, storage at room temperature could produce excessive pressure inside the container from carbon dioxide gas evolution. Refrigerated storage is recommended. This method for the preparation and sterilization of Renacidin irrigation is reasonably expedient, economical, and reliable.

Chemical Phenomena↗

PubMed1984

Efficacy of a topical antibiotic irrigant in decreasing or eliminating bacterial contamination in surgical wounds.

Using a simple in vitro system, the authors showed that colony counts of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas species can be reduced by 12%-56% with saline irrigation; the reduction of colony numbers, however, especially for S. aureus, was not always statistically significant. However, even if it were statistically significant, the amount of reduction would not be clinically significant. A topical antibiotic irrigant containing bacitracin/neomycin was effective against S. aureus, S. epidermidis-, and E. coli-treated agar plates. Except for a single plate containing Pseudomonas organisms, the growth of Pseudomonas colonies was also prevented by antibiotic irrigation. Tissue samples of muscle, fat, and bone obtained during operation showed antibiotic levels comparable with, and in most cases greater than, those found in the blood agar plates. These data may be clinically significant and suggest that bacitracin/neomycin irrigation can be safely used to reduce the incidence of postoperative infection.

Adipose Tissue↗

PubMed1984

Irrigation of the root canal system.

Debridement of the root canal system is essential for predictably successful endodontic therapy. The use of an endodontic irrigant during canal preparation is necessary to adequately debride the canal system. A review of the scientific evidence related to the desirable properties of an endodontic irrigant indicates that a solution of 5.25 per cent sodium hypochlorite is currently the irrigant of choice. This chemical agent exhibits powerful antimicrobial activity, is an excellent necrotic tissue solvent, and is the most efficient irrigant in removing organic debris from the root canal system.

Biomechanical Phenomena↗

PubMed1982

Prevention of endomyometritis using antibiotic irrigation during cesarean section.

After double-blind controlled studies demonstrated cefamandole nafate irrigation of the uterus during cesarean section to be effective in reducing the rate of endomyometritis, antibiotic irrigation was adopted as a standard procedure at Tripler Army Medical Center. The present study analyzes the outcome in patients undergoing cesarean section before (comparison group) and after (treatment group) routine use of antibiotic irrigation began. The incidence of endomyometritis in 100 patients from the comparison group was 20% and in 298 patients from the treatment group 1.7% (P less than .0001). Serum analysis for cefamandole nafate demonstrated little systemic absorption of the antibiotic. Cefamandole nafate intrauterine irrigation at cesarean section effectively prevents endomyometritis.

Adult↗

PubMed1982

Pre-operative whole-gut irrigation with mannitol.

Whole-gut irrigation preceded by oral mannitol administration as a method of preoperative bowel preparation was studied in 58 patients. Our results did not confirm the advantages described in the literature. Irrigation time, irrigation fluid volume, patient acceptability and the quality of bowel preparation were not improved, compared to our earlier studies with saline alone. Fluid retention was considerably diminished after mannitol preparation. A significant increase in postoperative septic complications was observed. Disadvantages and possible hazards of mannitol administration are discussed. Mannitol cannot be recommended as a safe and useful adjunct in whole-gut irrigation.

Abdomen↗

PubMed1980

Preparation of the colon by whole-gut irrigation--some practical remarks.

The importance of the mechanical cleansing of the bowel in relation to surgery of the colon is well understood. This article provides practical remarks concerning the technique of irrigation. Technical details are given on transforming a Bremshey hospital bed into a 'whole-gut irrigation bed'. The clinical procedure of the irrigation is described. We recommend irrigation by nasograstric tube with large amounts of fluids to all our patients when the bowel needs to be cleansed. Our specially designed whole-gut bed provides excellent comfort to our patients.

Beds↗