Pulsed lavage, is a form of mechanical hydrotherapy that uses a pressurized, pulsed solution to irrigate and debride wounds of necrotic tissue. In most cases, suction is used with pulsed lavage to remove both wound debris and irrigation solution. Pulsed lavage appears to improve growth of granulation tissue by debriding the wound bed of devitalized tissue without disrupting the underlying normal tissues. In addition, negative pressure created by the suction may stimulate granulation.
The clinician should keep in mind these 5 essential tips when performing pulsed lavage:
1- The force of pressure used during pulsed lavage can be adjusted. Regulate it according to the amount of necrotic tissue or slough requiring debridement and the patient’s tolerance. Settings can range from 4 to 12 pounds per square inch (psi), depending on the model. Increase the psi to obtain a greater amount of debridement. Decrease the psi to assist with pain tolerance.
2- If the patient continues to have pain during the procedure, several additional modalities can be used. The wound bed can be premedicated with a topical analgesic solution, such as lidocaine 4% solution. For additional relief, patients can be premedicated 30 minutes before the procedure with appropriate pain medication.
3- Antibiotics can be added directly to the normal saline solution if the wound has clinical signs of infection with purulence and devitalized tissue. This will help to reduce the bioburden on the surface of the wound and remove infected tissue.
4- Because of its easy mobility and relatively low cost, pulsed lavage can be used in many patient settings, acute care hospital at the bedside, long-term-care facility, outpatient physical therapy setting, (for example) daily or weekly or biweekly debridements.
5- One concern about pulsed lavage is the theoretical physiologic cooling of the wound bed, which can slow the wound healing process. Minimize this effect by warming the bag of normal saline solution to room temperature.