Use of Fluids to Cleanse Wounds - Term Paper Example

Reflective Clinical Assignment Name Institution Date Use of fluids (saline or water) to cleanse wounds Description Cleansing of wound involves fluid application to assist in removal of debris, exudates, contaminants and slough. Wound cleansing is among the major practices in clinical setting. On this day of my clinical placement, the nurse who was on night shift did her handover and I was left with another registered nurse who was also my mentor. I was assigned to a patient with a chronic wound. Since I had observed previous routine practice on wound cleansing, I knew I could perform the procedure without any issues. I started cleansing the wound using the little normal saline that I had. In the process, the registered nurse came and found that I was almost running out of normal saline and stated that I could use water instead since there was no more normal saline. This comment made me feel a bit confused since I did not know that water could be effective in cleansing wounds. I thereafter made an effort to research about the effectiveness of cleansing wounds using water. Literature Review Appropriate cleansing to generate wound environment effective for the healing is actually the major element of both acute and chronic management of wound. Every facility, health care providers, and institutions have different methods of cleansing. This is mainly based on individual experience in terms of wound cleansing. Cytotoxicity can be avoided when caution is taken in terms of choice of solution (Ljubic, 2013). Whether tap water should be regarded as a safe wound cleanser in provision of optimal healing of the wound is an issue of debate. Even though the debate is on-going, the studies conducted on the effectiveness of using tap water as a wound cleanser actually provide some evidence that water from the tap could be effective. Wound care is one of the routine practices in the clinical setting (Lippincott & Wilkins, 2010). However, a number of limitations cannot be overlooked. A lot of cleansing solutions have illustrated results that are safe and effective, while others might cause damage and destruction to cells that are significant to the process of healing. This is why choosing the correct solution may enhance the process of healing (McCulloch & Kloth, 2010). According to Cunliffe and Fawcett (2002) normal sterile saline is considered as the most suitable and preferred solution of cleansing since it is a solution that is nontoxic and isotonic and does not cause damage to healing tissues. On the other hand, tap water is frequently used and is therefore of concern as a solution of cleansing. Nevertheless, tap water and normal sterile saline have not been compared rigorously as solutions of wound cleansing in wounds that are either acute or chronic. In their analysis, Fernandez et al, (2001) reported various clinical implications concerning using tap water as a cleanser of the wound. A lot of these authors’ findings have supported the use of tap water as a routine wound cleanser for wounds that are either acute or chronic. However, the issue that tap water does not have unwanted effects cannot be ignored; hence caution must be taken into consideration. In children, normal sterile saline or tap water did not produce considerable differences in rates of infection. These findings seem to promote the ease and cost-effectiveness of using tap water (Fernandez et al, 2001). The particular group that reported nearly 45 percent decrease in the relative possibility of infection with water from the tap used poor means. Generally, the tap water was within body temperature and the normal sterile saline was at room temperature. It is imperative to observe temperature difference because this may have an effect on the process of healing. Therefore maintaining the normal body temperature could be of great help in facilitating the process of wound healing. It is argued that wounds heal effectively when at or above body temperature (Robert & Martin, 2013). Fernandez et al (2001) argued that tap water may perhaps be used for cleansing when generated from a source of potable water meant for drinking. Distilled and cooled water, boiled water were equated to saline, and no rise in the rate of infection was found, implying that these solutions may perhaps be used when there is no potable water. For centuries, tap water has been utilized as a wound cleanser with no evidence of associated risk of infection or adverse effects. The history of tap water use may advocate the safety of using tap water as a cleanser of a wound. The review by Fernandez et al (2001) points out a couple of limitations. In eight of the nine reviewed studies, randomization approaches were not exclusively explained or were question to selection bias. The analysis done by Fernandez et al (2001) on using clean water as a wound’s cleanser is somehow effective, but it is recommended that clean tap water might be as safe and effectual as normal sterile saline or sterile water, only narrow conclusions can be established. Water is regarded as a hypotonic solution, implying that it can bring about cell oedema and rupture when influenced by osmotic pressure. This is why water cannot be a suitable alternative for routine wound irrigation since it might be harmful to cells. In case wounds get exposed to water for a long duration, they are able to take in the liquid via osmosis, which rises the generation of exudates, resulting in more regular dressing changes. Proper wound management may put off complications’ risk (Ljubic, 2013). Sterile saline ought to be the cleansing solution of choice in the healthcare setting. This is because of the realistic physiological argument that supports saline use. In circumstances where some patients are not supposed to use normal saline, the study recommends that use of tap water can be effective. The fact that clean water is easy to obtain makes it a cheap solution for wound cleansing compared to normal saline. However, normal saline should not just be overlooked because it is quite costly (Chan et al, 2011). Integrating theory and practice With respect to absorption of water by the cells, it is imperative to consider how this can implicate practice. When water is absorbed by the cells, there is the possibility that the cells are able to burst. This would not be a pleasing experience for both the nurse and the client, particularly the client because of the discomfort caused. Nurses ought to provide wound management that is devoid of irritability Gannon, (2007). Irrigation of water on fresh tissue can bring about pain and important dissolved elements within the wound intracellular fluid might be lost. Losing important dissolved wound elements may possibly result in delayed process of wound healing, prolonged treatment and probably an extended discharge of the patient. Extended hospital stay may bring about other complications like hospital acquired infections (McCulloch & Kloth, 2010). In practice, irrigation by water may cause clients to feel greater pain and extra analgesia might then be needed. On the other hand, wound irrigation across the surface of wound that is open is aimed at obtaining wound hydration, removing debris that is deeper, and to facilitate visual examination (Lippincott & Wilkins, 2010). Regardless of likely theoretical cons, water ought to be considered in case a product license instructs that 0.9 percent saline cannot be applied, for instance when using products like Acticoat silver dressings. Sterile water is applicable provided a task is carried out effectively and without immersing or exposing the wound unreasonably (Fernandez et al, 2001). It is argued that it can be a safe practice to cleanse wounds using water on condition provided that long period of soaking the wounds is avoided. Selecting solutions for wound cleansing is very important so as to avoid causing detrimental effects on the patient. Most clinical settings choose tap water for wound cleansing probably because they consider normal saline as quite expensive. This is actually the case in the reflection when the registered nurse instructed me to use potable water because saline was actually out of stock. It is very vital to control wound temperature. Regardless of whether saline or water is used, it ought to be within body temperature since it can take approximately forty minutes for a wound to come back to normal temperature and around three hours for activity of leukocyte to recover following a change in dressing (Henton & Jain, 2012). In clinical practice, nurses are required to warm a solution to a range of 37 degrees Celsius to 42 degree Celsius and cleanse the wound in an effective way in order to minimize temperature fall. A daily change of dressing for a period of one week has the capacity to lack mitotic ability for around twenty one hours in a week unless immediate care is considered to lessen this. Maintaining most favourable wound temperature assists increase in blood flow to the bed of the wound, augment the rate of increase of wound tensile strength and enhance oxygen tension, which facilitates repair of wound. Additionally, it aids prevent multiplication of uncontrolled bacteria, hence decreasing infection risk. Hess, (2013), argues that wound healing can be optimized via appropriate management of the wound which entails harmful debris removal and controlling the burden of bacteria. Whatever solution that is used in wound care; nurses need to appreciate the effectiveness of the solution in cleansing wounds. According to Cooper & Seupaul (2012), even though a lot of literature favour normal saline use, assessing cytotoxicity is very crucial. Reflective practice helps students by fostering learning through personal experience. Reflection on an act, which occurs following an incidence, helps the practitioner or the student to re-examine an experience with the aim of investigating and learning from an action. Individually, reflection of the incidence has helped me enhance my knowledge concerning various solutions used for wound cleansing, with respect to normal saline and tap water. I learnt that even though normal saline is given the priority in wound cleansing, tap water on the other hand can be effective also provided some cautions are taken into consideration like not soaking the wound in water for longer durations so as to avoid cell lyses. Recommendations Future research ought to be carried out with actual randomized controlled experiments to evaluate cleansing and no cleansing to primarily establish the impacts of cleansing on infection in addition to healing. The choice to use water from the tap for wound cleansing ought to consider the water’s quality, wound’s nature and the general condition of the patient, not excluding the availability of comorbid conditions. Cleansing of wounds is frequently carried out as a custom practice, instead of an activity that is evidence based. It is advisable that the patient and the wound be assessed in order to establish whether tap water is appropriate for cleansing, or whether another solution of cleansing is safer. Additionally, it is vital to consider every wound individually so as to generate the optimal wound healing conditions. All in all, the effective solutions ought to be non-toxic and do not bring about pain to the patient in the process of usage. Bibliography Cunliffe, PJ & Fawcett TN, 2002, Wound cleansing: the evidence for the techniques and solutions used, Prof Nurse, Vol. 18, pp 95-99. Chan, M., et al, 2011, Tap water versus sterile normal saline in wound cleansing: A randomized controlled pilot study in community setting. Hong Kong: Faculty of Health and Social Sciences, The Hong Kong Polytechnic University. Gannon, R, 2007, Wound cleansing; sterile water or saline? Nursing Times, Vol. 103, Issue 9, pp 44-46. Cooper, DD., & Seupaul RA, 2012, Is Water Effective for Wound Cleansing?. Annals of Emergency Medicine, 60, 5, 626-627. Fernandez, R, et al, 2001, Wound cleansing: which solution, what technique? Prim Intention, Vol. 9, pp 51-58. Hess, CT., 2013, Clinical guide to skin & wound care. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Henton, J., & Jain A. 2012, Cochrane corner: water for wound cleansing, The Journal of Hand Surgery, European Volume, 37, 4, 375-6. Lippincott, W, & Wilkins, 2010, Wound care: An incredibly visual! pocket guide, Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Ljubic, A, 2013, Cleansing chronic wounds with tap water or saline: a review, Journal of Community Nursing, 27, 1, 19-21. McCulloch, JM, & Kloth L, 2010, Wound healing: evidence-based management, Philadelphia: F.A. Davis. Robert, W, & Martin U, 2013, Wound Cleaning and Wound Healing: A Concise Review, Advances in Skin & Wound Care, Vol. 26, Issue 4, pp 160-163. Read More