Irrigation syringe

[Elizabeth Tracy]

Hi,

I'd like to get a little syringe to add to my medical kit. My med kit is minimalist, but after a WFR/first aid class I'm realizing the importance of being able to irrigate wounds.

Anyone have a suggestion? Sizing (how many cc's)? I looked at syringes at amazon.com, and didn't really understand the syringe products.

Will probably want to buy more than one (more like 5), to give out to others.

– Elizabeth

[Jake D]

you could go ask the folks at your local pharmacy.. i'm not sure what size the ones for baby meds are. worth a shot.

a ziplock bag with a hole poked in it could work in a pinch too. or get a small bottle of Saline solution (which is what they use at the hospital) should be with the contact solution.. it has a dropper nozzle that will come out with force. when that runs out just use water after, they are refillable.

[NoCO-Jim]

10 ml (milliliters) size is what my daughter suggests, who is WFR qaulified, a nurse, and worked for Outward Bound.

[John S.]

http://store.nols.edu/Store/pc/viewPrd.asp?idproduct=11

[Mike M]

I use the 12ml hobby syringe, ones w/ the curved tip- the price is very reasonable on the NOLS one however- 10 ml is more than sufficient

[John S.]

I seen mention of 35-50 ml syringe with 18 gauge tip for best irrigation pressure. That may be more for a medical setting.

"High Pressure Irrigation:
– irrigation can remove enough wound bacteria to cross the threshold to non-infected states, but only if the irrigant is delivered with sufficiently high pressure to mechanically disrupt bacterial adherance to the wound surface;
– to be clinically effective wounds should be delivered by a fluid jet impacting on the wound with 7 pounds of pressure per sq inch;
– this level of fluid can be generated by forcefully expressing saline from a 35 cc syringe irrigation thru an 18 gauge needle, but it can not be generated by bulb syringe or by gravity flow;
– thus the notion that that large volume, low pressure wound flooding provides effective irrigation is erroneous and should be disgarded; "

http://www.wheelessonline.com/ortho/pressure_irrigation

[Elizabeth Tracy]

"thru an 18 gauge needle"

I'm confused. I thought we would bring a syringe that does NOT include a needle.

Medically clueless. Someone enlighten me?

– Elizabeth

[Jake D]

I think a 4oz bottle of saline solution that can be refilled will be enough force for most of what you will need to deal with in the woods. if you need a lot just dump a bottle of water on it. first aid is not rocket science.

last weekend i covered a rugby tournament and had 4 head lacerations.. i used a handful of gauze, 1/2 packet of steri strips and a bandaid.

i've never irrigated a wound with a syringe.. always saline out of a bottle or just the water bottle off the bench. i don't see why WFR would make it more complicated than that other than to sell gizmos you don't need.

[Dean F.]

Interesting then that the trend in trauma surgery is to go with low-pressure high-volume irrigation, nowadays. The concern is that in a highly contaminated wound the high pressure irrigant can cause bacterial translocation. Low-pressure is now official policy in Afghanistan. But this line of thought is being driven by war wounds, which are obviously different than civilian traumatic wounds. I have rarely seen a civilian injury that involved blowing a shovelful of dirt into a traumatic amputation stump. My mind boggles trying to think of a wound one could get in the wilderness that might be considered "highly contaminated" by my standards.

So,

Counterintuitively, very large syringes develop less pressure than smaller ones because the smaller ones apply all of the force on a smaller area. When I need a lot of pressure- for instance to unclog feeding tubes- I use a tiny tuberculin or insulin syringe, but clearly those are too small to be conveniently used to irrigate a wound. A honkin' big 50mL syringe is both inconvenient to carry and too low-pressured. A 10mL-20mL syringe sounds about right- I'm sure they will develop enough pressure without a needle. Don't forget to pluck out stones, bark, or whatever that is too big to irrigate away.

In the ER I usually just poke a few holes in the lid of a 1L saline bottle with an 18g needle and squeeze REALLY hard.

[j lan]

I love dean.

[Mary D]

I suspect it will take a while for the wilderness medicine and other civilian first aid protocols to catch up to the military protocol described by Dean. Dean, thank you! You sure make me feel better about not carrying a syringe! I figured that I could put a sewing needle hole in a plastic bag if needed (in fact, the WFA class I took two of years ago suggested this and that the syringe's place is primarily in a group kit). But if low pressure irrigation is preferred, I don't even need to do that!

The one time (in my 70-year backpacking career plus raising 4 kids) that I encountered a really contaminated wound was in a car campground. My kids were playing baseball (one-old-cat) with the kids in the campsite next door. One of the neighbor boys slid into home base (a good-sized rock) on one knee. Of course my kids called me over, telling the neighbor parents that I had just finished a mountaineering first aid class and could take care of it. Ha! I took one look at the knee–a big flap of skin peeled back with a lot of dirt imbedded in the tissue underneath–and strongly advised the parents that the two hour drive to the nearest ER was a really good idea. I pointed out that I could get the wound clean, but that the pain would be excruciating! In any case, a tetanus shot would be needed and stitches were probably indicated. I even offered to take care of the other kids, but they decided they might as well take the others since they'd have to eat dinner out anyway. They came back six hours later with a much happier boy, all cleaned and patched up (under local anesthesia) and ready to play ball again (although far more cautiously, with a substitute base runner) the next day! If we'd been 15 miles' hike from the nearest trailhead, of course, I'd have had to do the cleanup job.

It's really great to have a physician with so much trauma experience in the BPL community!

[John S.]

Paul Auerbach had this comment in 2007,

"Clean wounds first with clear, flowing water, then irrigate thoroughly with clean, disinfected water. Attempt to apply a significant irrigation pressure by using a plastic water bottle with a hole or a syringe attached to a needle or catheter of approximately 18-gauge. (Remember, the solution to pollution is dilution!)"

[Justin Mckinney]

The new Sawyer squeeze water filtration system, comes with a large syringe to back flush the filter, would work great to flush wounds.

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