Wound Treatment Without Pain? A Rinse Solution Can Help
Patients dealing with a healing wound may fear painful dressing changes. The wound bed is exposed and highly sensitive to pain due to damaged nerve endings. By using a rinse solution, however, we can eliminate the traumatic removal of the primary dressing, making the dressing change gentler for the patient. But which solutions are suitable for this purpose and which are not?
Limiting the Patient's Quality of Life
We define skin defects as damage to the integrity of the skin and subcutaneous tissue caused by various reasons. They are classified based on the healing time interval, the mechanism of formation, the depth and extent of tissue damage, or the etiology of the skin lesion.
Especially chronic wounds that take longer than 6 weeks to heal represent a serious problem for patients. They are at risk of local infection in the wound, which can very quickly lead to systemic sepsis. They often rely on the help of another person for daily self-care. And one of the most stressful factors is, of course, pain, which becomes an obstacle to treatment for many patients. Especially dressing changes can represent a very traumatic moment.
The Basis is Thorough Debridement
At each dressing change, it is necessary to remove infected and dead tissue from the wound bed. This reduces the chance of infection and initiates the healing process. But how to perform debridement painlessly? By applying rinse solutions. Some of these are now being replaced by more modern preparations that, due to their composition and properties, work better with the wound bed. Inappropriately performed rinsing, however, can do more harm than good. The consequences of such rinsing can include the undesired removal of growth factors or regenerative epithelium.
For the patient, using a correctly chosen rinse solution in treatment offers significant benefits. It ensures atraumatic removal of the primary dressing, rids the wound bed of microorganisms, and keeps it hydrated. A noteworthy advantage of an irrigation solution is also its ability to prevent premature surface healing.
How to Choose the Ideal Solution?
Choosing the right rinse solution is a critical step in treatment. Ideally, the irrigant should be isotonic, non-toxic, transparent, easy to sterilize, and financially accessible. However, such a solution does not exist in common practice. Therefore, it is necessary to assess the wound's character, healing phase, and the patient's overall (poly) morbidity.
Commonly Saline Solutions
These include physiological solution, whose advantage is particularly low toxicity. It is isotonic and does not interfere with the healing process. However, due to the absence of surface active substances, it cannot handle necrotic tissue. Unused contents should be discarded within 24 hours of opening the package.
In the absence of sterile physiological solution (or sterile water), it is recommended to use drinking water especially in “field” conditions. Study results suggest comparable infection rates in both adult and pediatric populations when using drinking water compared to the physiological solution. However, commonly available tap water may be colonized by bacteria, so it should be boiled before use. It is contraindicated for deep wounds.
Sterile Water
It has no antimicrobial properties, does not support healing in the presence of pathogenic biofilm. Because it is hypotonic, it acts hemolytically, and its long-term use promotes unwanted exudate formation in the wound. Excessive use can lead to water intoxication.
Sodium Hypochlorite (Dakin's Solution)
Used mainly for pressure ulcers with necrosis formation. It has bactericidal effects against most organisms of open wounds but is cytotoxic to healthy cells. Its use is contraindicated for longer than ten days. For its ability to eliminate odor, it is suitable for oncological defects.
Hydrogen Peroxide
Some studies suggest cytotoxicity to healthy cells, although other study results do not demonstrate a negative effect on the defect healing process. It does not significantly eliminate bacteria in the wound. It is contraindicated for cavity wounds. It represents an excellent chemical debridement.
Povidone-Iodine
Again, it is cytotoxic to healthy cells and granulating tissue. It forms an antimicrobial biofilm but may cause drying and redness of the surrounding skin. Indicated mainly for acute defects. Treatment lasts a maximum of 7 days.
Commercial Rinse Preparations
Their primary role is debridement. The ideal indication for their use is necrotic wounds. Preservatives extend their usable duration.
Conclusion
Almost every wound carries the risk of complications such as infection, leading to prolonged healing or longer hospitalization. Infection control and prevention are therefore essential to ensure the normal wound healing process. Wound cleaning using rinse solutions subsequently improves treatment outcomes for these patients.
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Sources:
1. Hlinková E., Nemcová J., Huľo E. et al. Management of Chronic Wounds. Grada Publishing, Prague, 2019: 126−129.
2. Gabriel A. Wound Irrigation. Medscape, 2021 Aug 27. Available at: https://emedicine.medscape.com/article/1895071
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