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PubMed2004

Treatment of field water with sodium hypochlorite for surgical irrigation.

BACKGROUND: Early irrigation and surgical debridement of high-energy wounds and open fractures effectively prevents infection. Rapid wound care has been maximized by the United States military's "forward surgical teams." However, the volume of sterile irrigant required to treat multiple patients with multiple wounds presents a significant logistical burden. Using ground-derived field water could eliminate this burden. METHODS: We collected 100 water samples from five sources. An initial bacterial count (CFU/mL) was determined before treatment. 5% sodium hypochlorite was then added to each sample to derive a concentration of 0.025%. After treatment, a final bacterial colony count was performed. RESULTS: We found no bacterial growth in 99/100 samples. One post-treatment sample grew a single colony of a Bacillus species not present in the pretreatment culture and was determined to be an air contaminant. CONCLUSIONS: Our field-expedient modification of Dakin's solution could substitute for sterile irrigation fluid when it is neither available nor logistically feasible.

Air Microbiology↗
PubMed1991

Monitoring of irrigating fluid absorption during transurethral prostatectomy. A study in anaesthetised patients using a 1% ethanol tag solution.

A simple, reliable method to detect absorption of irrigating fluid during transurethral prostatectomy is to tag irrigating fluids with 1% ethanol and monitor expired breath ethanol concentrations. This method correlated well (n = 0.79) with other existing methods of absorption monitoring in 20 anaesthetised patients. Ethanol (1%) tagging does not alter the optical quality of the irrigating fluid and is harmless to the patient. The technique is non-invasive, repeatable, cheap and gives instant results. It can be used in anaesthetised or awake patients and can detect absorption of as little as 100-150 ml in any 10-minute period.

Absorption↗
PubMed1989

The incidence of postoperative pain after canal preparation of open teeth using two irrigation regimes.

This study was carried out to evaluate the incidence of postoperative pain in 68 patients requiring root canal therapy. The teeth studied contained non-vital pulps and each had an existing open communication between the root canal and the oral cavity. Solvidont irrigating solution and medication paste were used on a group of 36 patients, while a second group of 32 patients had sterile isotonic sodium chloride2 (SISC) as the canal irrigant; no medicament was used on the second group. Three out of 36 patients (8 per cent) had mild discomfort following the use of Solvidont irrigant and paste. In the SISC group, 10 out of the 32 patients (31 per cent) complained of pain ranging from moderate discomfort to severe pain with associated swelling of soft tissues. Statistical analysis showed that the incidence of postoperative pain was high when the root canals of open teeth were not medicated.

Adolescent↗
PubMed1997

The effectiveness of three irrigating solutions on root canal cleaning after hand and mechanical preparation.

The purpose of this in vitro study was to evaluate and compare the efficacy of three irrigating solutions after hand and mechanical instrumentation. Sixty intact, single, straight-rooted, human teeth were used in this study. They were instrumented using K-files sizes 15 to 50 with hand or mechanical instrumentation. Mechanical instrumentation was with one of two handpieces, the Endocursor or Endolift. Instrumentation time for each file was 1 min. Each change of file was followed by irrigation with 1 mL 1% NaOCl. A flush of 2 mL of one of three irrigating solutions Largal Ultra, Tubulicid Plus or 50% citric acid, was administered at the end of the instrumentation and a final flush of 5 mL distilled water completed the treatment. The specimens were prepared and viewed under the scanning electron microscope. There were no significant differences in the smear layers produced by the three methods of instrumentation. The use of Largal Ultra and Tubulicid Plus removed considerable amounts of the smear layer regardless of the method of instrumentation. The use of 50% citric acid, on the other hand, removed the smear layer only partially whilst producing rather diverse findings.

Adult↗
PubMed2004

Effectiveness of electrochemically activated water as an irrigant in an infected tooth model.

AIM: To test the effectiveness of electrochemically activated aqueous solutions in the debridement of Enterococcus faecalis biofilms in root canals of extracted teeth. METHODOLOGY: Extracted, human, single-rooted teeth (198) assembled into 11 sets (n = 18) with matching anatomical characteristics were randomly assigned to eight experimental groups. After decoronation, the root canals were prepared to a standard size. Enterococcus faecalis biofilms were grown in the root canals of autoclaved, individually mounted teeth over 48 h. Electrolysed saline collected as anolyte at the anode and catholyte at the cathode were the test agents. The four ultrasonication and four without ultrasonication irrigant groups included: neutral anolyte (NA) (pH 6.5), acidic anolyte (AA) (pH 3.0), catholyte (C) (pH 11.5) and C alternated with neutral anolyte (C/NA). Phosphate-buffered saline (PBS) with and without ultrasonication formed negative and NaOCl (3%) positive control groups. After irrigation, root canal samples were serially diluted, cultured and enumerated. The data were analysed as ratios of residual colony-forming units (CFUs) in PBS versus the test irrigants and using multivariate regression. RESULTS: The NA and NA (ultrasonicated, U), C/NA and AA (U) groups had significantly (alpha = 0.05) less and C (U) and C/NA (U) significantly (alpha = 0.05) more bacteria (CFUs mL(-1)) compared with their respective PBS controls. Ultrasonicated C/NA had significantly (alpha = 0.05) higher CFU counts than the nonultrasonicated solution. Other comparisons between ultrasonic and nonultrasonic groups were not significant. Of the nonultrasonicated groups, C/NA and NA were most effective, whilst of the ultrasonicated groups, AA and NA were most effective. None of these was as effective as 3% NaOCl. CONCLUSIONS: All but two groups (AA and C) were significantly different from their PBS controls. There was a significant difference between the C/NA groups with and without ultrasonication but not between other combinations. NA (U) and AA (U) were the most effective test solutions but NaOCl (3%) gave by far the highest bacterial kills.

Colony Count, Microbial↗
PubMed1996

Renal function during intravenous infusion of urological irrigating fluids in the sheep.

BACKGROUND: Oliguria or anuria is an important sign of the transurethral resection syndrome, but the mechanism is not clear. METHODS: We gave an intravenous infusion of 40 ml/kg of glycine 1.5%, sorbitol 2%-mannitol 1%, and isotonic saline (control) in 6 conscious ewes and studied if irrigating fluids cause acute disturbances of kidney function. RESULTS: Both the electrolyte-free solutions induced an increase in urine flow and persistent hypo-osmolality. The renal clearances of p-aminohippuric acid and inulin as well as the unilateral renal blood flow, which was measured via ultrasonic flow probes, increased in response to infusion of glycine but not to sorbitol-mannitol. After the infusions, the renal clearances decreased transiently to below baseline levels. Hypertonic saline was given after half of the infusions of electrolyte-free irrigating fluid. This treatment redistributed water from the cells to the extracellular fluid, but had no effect on renal function. CONCLUSIONS: We conclude that 2500 ml of electrolyte-free irrigating fluid had no detrimental effects on kidney function in sheep. The changes we observed were essentially the same as after infusion of isotonic saline.

Animals↗
PubMed1997

Comparison of the effect of two heights of glycine irrigation solution on serum sodium and osmolality during transurethral resection of the prostate.

BACKGROUND: The absorption of sodium-deficient, hypotonic irrigation solution is believed to contribute, in certain cases, to hyponatraemia and hypo-osmolality and, in severe cases, to the so-called transurethral resection of the prostate (TURP) syndrome. METHODS: The effect of the height of 1.5% glycine irrigation solution during intermittent-flow TURP on serum sodium and osmolality was studied peri-operatively in 40 patients. The height of the glycine was set at 70 (n = 20) or 150 (n = 20) cm above the operating table. RESULTS: We found no statistically significant difference in the measured serum sodium (P = 0.929) and osmolality (P = 0.260) values between the two groups during the 24 hr study period. CONCLUSIONS: The height of the irrigation solution is not important in the development of hyponatraemia and hypo-osmolality, and other factors are probably more important.

Aged↗
PubMed1976

Further studies on effects of irrigation solutions on rat bladders.

Further studies on the effects of certain irrigating fluids on the rat bladder for 18 hours are reported. The results have shown that the degradation product p-choloroaniline is not a significant factor in chlorhexidine-digluconate associated erosive cystitis. A high percentage of kanamycin-colistin and povidone-iodine irrigations were associated with erosive cystitis and suggested a possible complication with human usage. Picloxydine irrigations appeared to have a lower incidence of erosive cystitis but further studies would have to be performed before it could be recommended for use in urological procedures.

Aniline Compounds↗
PubMed1981

The use of cooled irrigating fluid for transurethral prostatic resection.

Forty patients selected for transurethral prostatic resection (TUR) were randomly allocated to one of 2 groups. Irrigating fluid used in the first group of 20 patients was cooled to a constant 8 degrees C; in the second group fluid at ambient temperature was used. Measurements were made of the volume of irrigating fluid used and haemoglobin loss during and after operation; the weight of resected tissue and its histological appearance were also studied. The core temperature of each patient was monitored throughout the operation. Significantly less irrigating fluid was used in the group receiving cooled fluid. Although per-operative and post-operative haemoglobin loss was also markedly reduced in this group, the difference failed to achieve statistical significance. The clarity of the operative field was considerably improved by the use of cooled fluid.

Hemoglobins↗
PubMed1988

The use of noxythiolin (Noxyflex 'S') as an antiseptic irrigant in upper urinary tract drainage following percutaneous nephrolithotomy.

Percutaneous nephrostomy drainage for the relief of obstruction or stone removal has become a common procedure. Despite the routine use of prophylactic antibiotics, nephrostomy urine frequently becomes infected (approximately 30% of cases). Noxythiolin irrigation has been used to prevent and treat bladder infections. A double-blind, placebo controlled study was carried out in 20 patients undergoing a single-stage percutaneous nephrolithotomy to evaluate the use of noxythiolin as an upper urinary tract antiseptic. In the patients whose nephrostomy tubes were irrigated with a 2.5% solution of noxythiolin, significant bacterial infection was eliminated from the nephrostomy urine and colonisation of the catheter tip was markedly reduced. Noxythiolin also rendered pre-operative infected bladder urine sterile. There were no untoward local or systemic sequelae in either group of patients. This study indicates that irrigation of the upper urinary tract with noxythiolin solution is safe and may be a useful adjunct to reduce the risk of sepsis in patients undergoing percutaneous drainage procedures.

Adolescent↗
PubMed1989

Irrigation and acute ureteric dilatation--as for ureteroscopy.

The effects of irrigation with sterile and infected saline after acute ureteric dilatation by graded Teflon dilators were evaluated renographically and histologically in minipigs. The minipig ureter was dilated from its normal calibre of 4 F to 10 F, and 100 ml of sterile or infected saline were then introduced from a height of 60 cm under gravity. One week after irrigation and dilatation the ipsilateral kidney was either functioning less than 10% or there was an obstructive nephropathy. Histology at 3 months suggested that extravasation of infected irrigating fluid was the most likely cause of ureteric stricture formation.

Animals↗
PubMed1989

Glycine irrigation and urinary oxalate excretion.

The short-term effect of glycine supplementation on urinary oxalate excretion was studied. An intravenous infusion of 1 litre of a solution of 2.2% glycine, 1.5% glycine + 1% ethanol or 5% mannitol (control) was given on 13 occasions to 5 healthy volunteers. Glycine irrigation was used in 9 patients undergoing transurethral prostatic resection and the absorption of irrigant was measured volumetrically (range 0-2.71). The results suggest that glycine irrigation in transurethral prostatic surgery does not raise the urinary oxalate level in the early post-operative period.

Absorption↗
PubMed1993

Absorption of irrigating fluid and height of fluid bag during transurethral resection of the prostate.

The purpose of this study was to examine the relationship between the static pressure and the absorption of irrigating fluid during transurethral resection of the prostate. We measured the absorption by the ethanol method in 550 operations during which the fluid bags were placed randomly at distances of 60-65, 70-75, 80-85 or 90-100 cm above the operating table. There was no difference in the volume of irrigant absorbed at different bag heights or any association between fluid height and absorption when different ranges of fluid absorption were analyzed. This suggests that irrigant absorption cannot be prevented by placing the fluid bags at a certain height within the range of 60 to 100 cm above the operating table.

Absorption↗
PubMed1993

Is planned continuous irrigation indicated for haemorrhage following transurethral resection of the prostate?

A prospective audit was carried out of this unit's policy of non-irrigation following transurethral prostatectomy (TURP). Over an 11-month period 121 TURPs were performed. Only 29 patients required intervention to maintain bladder drainage post-operatively, 23 of these requiring bladder washout alone. In the remaining 6 patients catheter change and continuous irrigation were required. The weight of tissue resected was the only factor investigated which bore a significant relationship to the necessity for further intervention in bladder drainage post-operatively. Despite this, patients requiring continuous irrigation post-operatively could not be easily identified prior to or during surgery.

Aged↗
PubMed1993

The effect of prostatic capsule perforation on the absorption of irrigating fluid during transurethral resection.

Thirty patients undergoing transurethral resection of the prostate using ethanol-tagged irrigating fluid were investigated in order to study the effects of a breach in the prostatic capsule. Measurements were made of end-tidal ethanol (ET-ethanol) in the expired air, serum glycine and sodium, haemoglobin, blood loss and volumetric determination of irrigating fluid absorption. Perforation of the prostatic capsule occurred in 13 patients (Group P), with 17 judged to have no perforation (Group NP). In all Group NP patients the ET-ethanol remained below 0.05/1000, serum sodium decreased by < or = 3 mmol/l and serum glycine remained < 1.5 mmol/l. ET-ethanol was significantly increased in Group P, rising to between 0.1 and 0.45/1000 in 5 patients, 3 of whom showed a reduction in serum sodium > 5 mmol/l. Five patients in Group P demonstrated significantly raised serum glycine concentrations up to 15 mmol/l. These findings suggest that perforation of the prostatic capsule may lead to rapid absorption of irrigating fluid, and that ET-ethanol monitoring is a useful method of detecting this quickly.

Absorption↗
PubMed1995

Treatment of catheter-associated Candiduria with fluconazole irrigation.

OBJECTIVE: To examine the safety and efficacy of fluconazole in patients with a permanent nephrostomy or suprapubic catheter in the prevention of candiduria. PATIENTS AND METHODS: Twenty patients with a nephrostomy or suprapubic catheter who had at least two positive urine cultures with a minimum of 15,000 col/mL Candida counts were studied. The catheters were irrigated with fluconazole solution prepared as 1 mg/mL with normal saline. Repeated urine cultures were obtained. RESULTS: In 17 patients Candida was eradicated from the urine by the third to sixth day of irrigation. No side-effects were noted. CONCLUSION: Fluconazole as an irrigant is effective and safe in the treatment of catheter-associated candiduria, which can be eliminated without changing the catheter.

Adult↗
PubMed2005

Irrigation with antibiotic-containing solutions for the prevention and treatment of infections.

Administration routes for antimicrobial agents used in clinical practice include the topical, inhaled, enteral and parenteral routes. An antibiotic administration route used frequently worldwide, although not well-studied, involves the irrigation of wounds with antibiotic-containing solutions for the prevention and treatment of infections. This review considers the data available from various experimental and clinical studies in order to provide an update on the use of antibiotic-containing solutions in modern clinical practice. Although irrigation with antibiotic-containing solutions has been suggested to be beneficial in the prevention or treatment of infections in several settings and patient populations, no firm, evidence-based recommendations can be made regarding its use until additional data from well-designed, randomised clinical trials become available. Current exceptions include empyema following lobectomy, or pneumonectomy and pyocystis (vesical empyema), since irrigation with solutions containing antimicrobial agents seems to be a crucial component of the management of these conditions.

Anti-Bacterial Agents↗
PubMed1981

Optimal dosage of chlorhexidine digluconate in chemical plaque control when applied by the oral irrigator.

Chlorhexidine digluconate for chemical plaque control was tested in different concentrations using a fractionated jet oral irrigator. The inhibition of plaque formation and the prevention of gingival inflammation were evaluated in a double-blind study. During a 10-day period of abstinence from any mechanical oral hygiene procedures, the pattern of plaque formation and gingivitis development under the influence of chemical plaque control was analyzed. As a positive control, one group rinsed twice daily with 30 ml of a 0.2% chlorhexidine solution while a group applying 600 ml of a placebo solution served as a negative control. Forty dental students and assistants with plaque-free dentitions and healthy gingival tissues were divided into four groups. After a 10-day period of no oral hygiene, a recovery period of 11 days with perfect oral hygiene was again instituted. This experiment was repeated three times so that a total of 10 concentrations in the irrigator, the control rinsing and the placebo control could be evaluated. Daily application of 600 ml of a 0.001% (6 mg), 0.0033% (20 mg), 0.005% (30 mg), 0.01% (60 mg), 0.02% (120 mg), 0.05% (300 mg) and 0.1% (600 mg) and 400 ml of a 0.015% (60 mg), twice 400 ml of a 0.015% (120 mg) and 400 ml of a 0.02% (80 mg) solution of chlorhexidine was tested. At the start of each experimental period (day 0), after 3, 7 and 10 days and 11 days following reassuming oral hygiene procedures, the plaque accumulations were determined using the Plaque Index System (Silness & Löe 1964) and the development of gingivitis was evaluated according to the criteria of the Gingival Index System (Löe & Silness 1963). The results suggested that one daily irrigator application of 400 ml of a 0.02% chlorhexidine solution was the optimal and lowest concentration and dose to be used for complete inhibition of dental plaque.

Adult↗