Wound Irrigation and Drainage: A Clinician’s Guide

According to data in the literature on wound irrigation, an estimated 12.2 million patients are treated in emergency rooms for wound closure and wound management every year, with the most common complication being infection. Severe infections occur in an estimated 2.47% of those sutured wounds.

What’s the best defense against such complications? Here’s what the authors recommend:

“Wound irrigation is an essential part of wound management and is the single greatest intervention in wound care to reduce the risk of infection.”

Clearly wound irrigation is critical, but it should come as no surprise that it typically isn’t used alone. Proper wound treatment often involves the trifecta of wound irrigation, wound drainage, and debridement. Keep reading to learn more about these medical procedures and how they work together for effective wound treatment.

The Importance of Wound Irrigation, Drainage, and Debridement

Wound irrigation, wound drainage, and debridement are three closely related care procedures that are key  in wound treatment, but there are key distinctions between them.

Let’s start with an overview of each procedure.

• Wound irrigation flushes a wound with a liquid to remove debris. It’s typically used for acute wounds to cleanse the area, for surgical wounds to remove debris and prevent infection, and for chronic wounds to help cleanse and reduce the bacterial load in ulcers or pressure sores.
• Wound drainage removes excess fluid from a wound. It’s typically used for surgical wounds to prevent fluid buildup, for abscesses to drain pus, and for chronic wounds to prevent excessive drainage in wounds like pressure and diabetic ulcers.
• Debridement removes dead or damaged tissue from a wound. It’s typically used for necrotic wounds with dead or dying tissue, for diabetic foot ulcers to remove infected or non-viable tissue and reduce the risk of amputation, and for burns to remove damaged skin.

In many cases, all three procedures are used together to optimize wound healing. For example, a wound may be irrigated to remove debris, then debrided to remove dead tissue, and finally drained to prevent fluid buildup.

The specific combination and order of irrigation, drainage, and debridement will depend on the type of wound, its severity, and the patient’s overall health.

The Purpose of Each Wound Care Procedure

Though there are some overlapping intentions with each procedure, wound irrigation, wound drainage, and debridement all play a specific part in the overall wound treatment process.

The purpose of wound irrigation is to:

• Reduce the risk of infection. By removing debris and bacteria, irrigation helps to create a clean environment that is less likely to become infected.
• Promote healing. A clean wound is more conducive to healing, as it allows tissues to repair themselves without any interference from harmful substances.
• Prevent abscess formation. Irrigation can help to prevent the accumulation of pus, which can lead to abscess formation.
• Improve wound appearance. By removing dead tissue and debris, irrigation can help to improve the appearance of the wound and reduce scarring.

While wound drainage also helps to address some of the aspects above, its purpose is to:

• Remove excess fluid. Wounds can lead to an accumulation of various fluids, such as blood, pus, and serosal fluid, which provide an ideal environment for bacteria to thrive. Drainage systems effectively remove these excess fluids, preventing their buildup and reducing the risk of infection.
• Reduce pain. Excess fluid in a wound can cause discomfort or pain. Drainage can help to alleviate this pain by reducing pressure on the wound.
• Help close wounds. In some cases, drainage systems can be used to help draw the edges of a wound closer together, promoting healing and reducing the need for stitches.

Lastly, the purpose of debridement is to:

• Eliminate dead tissue. Dead tissue can provide a breeding ground for bacteria, increasing the risk of infection.
• Ease pain. Dead tissue can be a source of pain and discomfort for patients. Removing it can help to reduce pain and improve overall comfort.

Types of Wound Drainage

There are two main approaches to wound drainage: open and closed. See how they differ below.

Open Drainage

Open drainage involves placing a non-absorbent gauze dressing over the wound, allowing fluids to drain directly onto it. You may also use an antimicrobial cream or ointment in conjunction with the dressing to mitigate infection. The dressing should be changed regularly.

The advantages of open drainage are that it’s simple and cost effective. However, it can lead to skin irritation and may not be practical for large volumes of drainage, which can ultimately increase the risk of infection.

Closed Drainage

Closed drainage uses draining tools to collect fluid and prevent it from pooling in the wound. These drains typically have a bulb or chamber that is squeezed to create suction, drawing fluid into the drain. They also make use of gauze to protect the wound, secure the drain in place, and absorb any excess fluid that may leak from the wound area.

The advantages of closed drainage are that it’s more effective than open drainage at managing large volumes of drainage and reducing the risk of infection. In addition, it often requires less frequent dressing changes.

Unlike its open counterpart, closed drainage has a few specific drainage systems practitioners typically employ, including:

• Jackson-Pratt drain. This is a small, bulb-shaped drain that is placed under the skin near the wound. The bulb is squeezed to create suction, drawing fluid into the drain. It’s often used for surgical wounds and abscesses.
• Hemovac drain. Similar to the Jackson-Pratt drain, the Hemovac uses a vacuum to remove fluid. However, it has a larger capacity and is often used for larger wounds or when significant drainage is expected or needed.
• Wound vacs. This advanced system utilizes negative pressure to draw fluid out of the wound and promote healing. It can also be used to help close wounds. This system is particularly effective for complex wounds, such as pressure injuries or diabetic foot ulcers.

Which Drainage Option Should You Choose? Consider these key factors when deciding which type of wound drainage to choose. Wound size and location: Larger wounds, or those located in areas with poor circulation, may require more robust drainage systems. For instance, a large surgical wound on the abdomen might benefit from a Hemovac drain, while a smaller wound on the arm might be adequately managed with a Jackson-Pratt drain. Expected drainage: If you anticipate significant drainage, a closed system like a Hemovac or Wound Vac might be more appropriate. For example, a deep surgical incision or an abscess might require a Hemovac drain to handle the expected volume of fluid. Patient condition: Patients with underlying health conditions or those on certain medications may require specific drainage methods. For instance, patients with blood clotting disorders might require a gentler drainage system to avoid excessive bleeding. Type of wound: The nature of the wound (e.g., surgical, traumatic, chronic) can also influence drainage choices. For example, a minor wound will likely heal fine with a simple combination of gauze and antimicrobial cream or ointment. In contrast, a chronic wound like a pressure ulcer may benefit from a wound vac system due to its ability to handle more drainage.

7 Types of Wounds That May Not Need Irrigation

Not every wound requires irrigation. In some cases, irrigation may do more harm than good if it forces bacteria and debris-containing fluids further into the wound or other body spaces. Alternatively, irrigation may simply be unnecessary if the wound is in an area of the body that is highly vascular.

However, if the wound is deep or there are signs of an infection, irrigation may be necessary. Additionally, if the wound is on a part of the body that is prone to contact with dirt or bacteria, such as the soles of the feet, irrigation may be needed to prevent infection.

Providing that the wound does not exhibit the above traits, here are a few types of wounds that generally don’t need irrigation.

1. Wounds with Active Bleeding

The force of the irrigation fluid can disrupt delicate blood clots that are forming to control bleeding. This can lead to increased blood flow and potentially worsen the hemorrhage. If bleeding is not controlled, it can hinder the healing process. The constant loss of blood can deprive the wound of essential nutrients and oxygen, making it difficult for tissues to repair themselves.

In addition, incomplete wound irrigation can lead to the persistence of debris or pus inside the wound. This can result in abscesses with sinus tract formation.

2. Scalp Wounds

While the scalp is prone to cuts and scrapes, especially from accidents or hair styling injuries, minor wounds often do not require irrigation. The hair itself can act as a barrier, preventing dirt and debris from entering the wound.

3. Face Wounds

The skin on the face is delicate and sensitive, and it’s important to avoid irritating it. For minor cuts and scrapes, gentle cleansing with a mild soap and water is often sufficient. Irrigation can be too harsh on the facial skin and may increase the risk of scarring.

4. Elbow and Knee Wounds

The skin on the elbows and knees is tougher compared to skin on the rest of the body, so it can generally withstand minor injuries without requiring wound irrigation.

5. Minor Cuts and Scrapes

These superficial wounds often heal on their own without irrigation, especially if they are clean and not embedded with dirt or debris.

6. Minor Burns

Burns should be treated immediately with cool running water. However, once the burn has been cooled, irrigation is generally not necessary. In fact, the force of irrigation fluid can dislodge damaged skin, exposing underlying tissues to infection. This can increase the risk of serious complications, such as cellulitis or sepsis.

7. Closed Wounds

Wounds that have closed up on their own, such as puncture wounds caused by nails or thorns, generally do not need irrigation unless there are signs of infection.

Wound Irrigation Is the Key to Timely Healing

Regardless of the type of wound a patient has suffered, wound irrigation is typically a key procedure in the treatment process. When combined with wound drainage and debridement, any wound can be properly cared for and ensure the patient starts off on the right foot in their healing journey.