Continuing our series on adjunctive therapies, this week we will examine the use of pulsed lavage in wound care.
Treatment Overview Pulsed lavage (pulsatile jet lavage) is mechanical water therapy used to assist in debriding wounds of necrotic tissue.
It utilizes a pressurized pulsed solution, sometimes in conjunction with suction, to help rid the wound of debris.
It is thought that pulsed lavage improves the development of healthy, granulating tissue.
The goal is to remove unwanted tissue without disturbing healthy tissue.
The pressure of irrigation is measured in pounds per square inch (psi), and a pressure of 4 to 15 psi is considered safe and effective.
Normal saline is the most commonly used irrigating solution.
Indications

• Cleansing/debriding a variety of wounds, including venous, pressure and neuropathic ulcers
• Burns
• Traumatic wounds
• Surgical wounds
• Patients who are not candidates for whirlpool therapy due to health condition (i.
  e.
  venous insufficiency, incontinence, certain cardiac conditions, patients in an ICU)
• Wounds with tunnelling (if the lavage system has the correct tips)

Contraindications

• No absolute contraindications exist when a psi of 15 or less is used
• Some wounds may be better suited for whirlpool therapy due to their nature (i.
  e.
  extensive burns, psoriasis, Kaposi's sarcoma)

Advantages

• Greater amount of debridement can be obtained by increasing the psi
• Antibiotics can be added to the irrigation fluid to help reduce the wound's bioburden
• Pulsed lavage is relatively cost-effective
• Pulsed lavage systems are easily mobile and can be used in a variety of patient care settings
• Decreased risk of contamination of the wound in comparison to whirlpool therapy
• Decreased risk of maceration of healthy surrounding tissue, as may occur with whirlpool therapy
• The technician can easily control the pressure applied to the wound

Disadvantages

• Pulsed lavage can be a painful procedure for some patients
• Cooling of the wound bed may occur when the irrigating solution is not sufficiently warm, resulting in a delay in wound healing
• Pulsed lavage is time consuming- treatments may take 15 to 30 minutes and may need to be done daily (twice daily if the wound has more than 50% necrosis)

For patients who experience pain during the procedure, appropriate pain medications can be administered 30 minutes prior to treatment; alternately, a topical anaesthetic, such as lidocaine, can be used to ease discomfort.
In addition, the psi can be decreased if pain still persists despite use of other methods of pain relief.