Normal Saline Solution in 5% Dextrose or D5NSS is a hypertonic solution.

It can be used for the temporary treatment of shock if plasma expanders are not available. However, do not administer this IV for clients with cardiac or renal conditions. Hypertonic Solutions Hypertonic solutions have tonicity or solute concentration in ECF greater than that of the ICF. Therefore, it pulls fluids out of the ICF...... and the cell shrinks. Examples of Hypertonic Fluids: 1. D5NSS (5% Dextrose in normal saline solution)

2. D5 in 0.45% NaCl ( 5% Dextrose in half strength normal saline)

3. D5LR (5% Dextrose in Lactated Ringer's Solution)

4. D10W ( 10% Dextrose in water)

5. D50W50 (50% Dextrose in 50 ml of water)

Purpose: Hypertonic solution draws fluids from the ICF causing cells to shrink and ECF to expand. Given to patients with hyponatremias (Na deficits) with edema Aside from being isotonic, hypotonic & hypertonic. IVF may also come in a form of nutrient solution, electrolyte solution, alkalyzing solution & acidifying solution.... Have a greater concentration of solutes than plasma vIt draw fluid out of the intracellular and

interstitial compartments to vascular compartment, expanding vascular volume. Do not administer to clients with kidney or heart disease or clients who are dehydrated. Watch for signs and symptoms of hypervolemia vExamples; 5% dextrose in normal saline/D5NSS, 5% dextrose in 0.45% Nacl, 5% dextrose in lactated Ringers / D5LR

WOUND IRRIGATION
Irrigation cleans tissues and flushes cell debris and drainage from an open wound. Irrigation with a commercial wound cleaner helps the wound heal properly from the inside tissue layers outward to the skin surface; it also helps prevent premature surface healing over an abscess pocket or infected tract. Performed properly, wound irrigation requires strict sterile technique. After irrigation, open wounds usually are packed to absorb additional drainage. Always follow the standard precaution guidelines of the Centers for Disease Control and Prevention (CDC).

Equipment Waterproof trash bag linen-saver pad emesis basin clean gloves sterile gloves goggles gown, if indicated prescribed irrigant such as sterile normal saline solution sterile water or normal saline solution soft rubber or plastic catheter sterile container materials as needed for wound care sterile irrigation and dressing set commercial wound cleaner 35-ml piston syringe with 19G needle or catheter skin protectant wipe.

Preparation of equipment Assemble all equipment in the patient's room. Check the expiration date on each sterile package and inspect for tears. Check the sterilization date and the date that each bottle of irrigating solution was opened; don't use any solution that's been open longer than 24 hours. Using aseptic technique, dilute the prescribed irrigant to the correct proportions with sterile water or normal saline solution, if necessary. Let the solution stand until it reaches room temperature, or warm it to 90 to 95 F (32.2 to 35 C). Open the waterproof trash bag, and place it near the patient's bed. Position the bag to avoid reaching across the sterile field or the wound when disposing of soiled articles. Form a cuff by turning down the top of the trash bag to provide a wide opening, which will keep instruments or gloves from touching the bag's edge, thus preventing contamination.

Implementation

Check the physician's order, and assess the patient's condition. Identify the patient's allergies, especially to povidone-iodine or other topical solutions or medications. Explain the procedure to the patient, provide privacy, and position the patient correctly for the procedure. Place the linen-saver pad under the patient to catch any spills and avoid linen changes. Place the emesis basin below the wound so that the irrigating solution flows from the wound into the basin.

Wash your hands thoroughly. If necessary, put on a gown to protect your clothing from wound drainage and contamination. Put on clean gloves.

Remove the soiled dressing; then discard the dressing and gloves in the trash bag. Establish a sterile field with all the equipment and supplies you'll need for irrigation and wound care. Pour the prescribed amount of irrigating solution into a sterile container so you won't contaminate your sterile gloves later by picking up unsterile containers. Put on sterile gloves, gown, and goggles, if indicated.

Fill the syringe with the irrigating solution; then connect the catheter to the syringe. Gently instill a slow, steady stream of irrigating solution into the wound until the syringe empties. (See Irrigating a deep wound, page 202.) Make sure the solution flows from the clean to the dirty area of the wound to prevent contamination of clean tissue by exudate. Also make sure the solution reaches all areas of the wound.

Refill the syringe, reconnect it to the catheter, and repeat the irrigation. Continue to irrigate the wound until you've administered the prescribed amount of solution or until the solution returns clear. Note the amount of solution administered. Then remove and discard the catheter and syringe in the waterproof trash bag. Keep the patient positioned to allow further wound drainage into the basin. Clean the area around the wound with normal saline solution; wipe intact skin with a skin protectant wipe and allow it to dry well to help prevent skin breakdown and infection. Pack the wound, if ordered, and apply a sterile dressing. Remove and discard your gloves and gown. Make sure the patient is comfortable. Properly dispose of drainage, solutions, and trash bag, and clean or dispose of soiled equipment and supplies according to facility policy and CDC guidelines. To prevent contamination of other equipment, don't return unopened sterile supplies to the sterile supply cabinet.

Special considerations

Try to coordinate wound irrigation with the physician's visit so that he can inspect the wound. Use only the irrigant specified by the physician because others may be erosive or otherwise harmful. Remember to follow your facility's policy and CDC guidelines concerning wound and skin precautions. Irrigate with a bulb syringe if the wound is small or not particularly deep or if a piston syringe is unavailable. However, use a bulb syringe cautiously because this type of syringe doesn't deliver enough pressure to adequately clean the wound.

Home care If the wound must be irrigated at home, teach the patient or a family member how to perform this procedure using strict aseptic technique. Ask for a return demonstration of the proper technique. Provide written instructions. Arrange for home health supplies and nursing visits, as appropriate. Urge the patient to call the physician if he detects signs of infection.

Complications Wound irrigation increases the risk of infection and may cause excoriation and increased pain. Pressure over 15 psi causes trauma to the wound and directs bacteria back into the tissue. Documentation Record the date and time of irrigation, amount and type of irrigant, appearance of the wound, sloughing tissue or exudate, amount of solution returned, skin care performed around the wound, dressings applied, and the patient's tolerance of the treatment.

Irrigation & Debridement Procedures

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Irrigation and debridement procedures are an aspect of wound care. Irrigation is a precautionary method to help prevent the development of infections. Debridement is conducted to remove dead or unhealthy tissue in order to promote healing of a wound. Irrigation is often conducted prior to a debridement procedure to help promote the effectiveness of the removal of dead skin and tissue.

Irrigation

Use proper safety equipment when irrigating.

Irrigation flushes out wound debris by using instruments with pressurized fluids. To effectively clean a wound, pressure of the fluid must be no more than eight to 12 pounds per square inch. If the pressure exceeds 15 psi, bacteria can be pushed further into a patient's wound. Wounds irrigation must be conducted in a hygienic environment. Wash your hands prior to irrigation procedures. Use gloves, a gown and a mask to prevent the spraying of irrigation fluids and debris onto you.

Irrigation Technique

You can use a 30-to-35ml syringe.

According to the American Pediatric and Surgical Nurses Association, using saline as an effective cleaning agent for wound care is acceptable. Prior to irrigating the wound, the wound is gently cleansed with saline. Clean the wound from the center of the affected area, moving towards the outside of the wound. Don't use skin cleansers (soap) or antiseptics, as this can kill cells. Use a 30-to-35ml syringe or squeeze bottle with sterile saline. Apply steady pressure from the syringe or squeeze bottle and blot up any excess drainage with sterile gauze.

Debridement

Forceps, scapals or tweezers can be used for debridement.

Debridement should be conducted once tissue becomes blackened or yellowish, leathery and when the skin is easily sloughed off. The Mayo Clinic recognizes that using surgical debridement is one of the quickest methods to healing a wound. However, this method can be painful to the patient. Forceps and tweezers may also be used to help remove dead tissue and skin. General anesthesia should be administered prior to the procedure to help minimize discomfort to the patient.

Debridement Types

Larvae of the green bottle fly can help with debridement.

There are various types of debridement procedures. Surgical debridement may be done if a patient is suffering from inflammation of the wound. Mechanical debridement may initiate healing by irrigating the wound or applying a wet dressing. A wet dressing dries overnight, is remoistened and then removed. The dressing pulls away wound debris. Autolytic debridement is a type of dressing that retains fluids within the patient's body to help flush out the wound. Biological debridement uses the larvae of Lucilia sericata, or the green bottle fly, to digest necrotic tissue.

Debridement Complications
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While complications from debridement are rare, they do occur. Debridement can sometimes result in delayed healing, infection, the loss of healthy tissue with mechanical debridement and bleeding of the wound area. After a debridement procedure has been done, it's important to assess the patient's wound for swelling, redness, discharge, excessive bleeding, a change in coloration of the wound (turning white, blue or black) and increase in pain levels, particularly to the level that pain medication doesn't work or relieves pain poorly.