Trick of the Trade: DIY Squirt Bottle Wound Irrigation

2017-07-30T14:37:24+00:00

wound irrigationWound irrigation is arguably one of the most important steps in closing a laceration, because all lacerations should be considered to be contaminated. Irrigation is considered the foundation in preventing infection. A common way to cleanse a wound is to irrigate a wound using a 20 cc syringe, angiocatheter, and splash protector. To achieve 500 cc of irrigation, however, it would require 25 syringe refills! Is there a better, cost-effective alternative?

Trick of the Trade: “Squirt bottle” irrigation setup

Equipment

  • A 500 cc bottle of sterile water or normal saline (bottle of drinking water could even work if not in a clinical environment)
  • Eye protection
  • Alcohol swab
  • 18- or 20-gauge needle

Technique

  1. Clean the side of the bottle with an alcohol wipe
  2. Use the needle to puncture the top or side of the irrigation bottle 10-20 times in an evenly spaced pattern. If you are having trouble puncturing the side of the container you can luer-lock the needle onto a syringe for a better grasp.
  3. Firmly squeeze the container to get a strong stream of pressurized fluid until the bottle runs dry.

This irrigation trick works particularly well for cleaning out scalp wounds with a densely matted blood.

Caution: Need personal protective equipment

Because method does not protect from splatter, gloves and a face mask with eye shield is mandatory. A gown is recommended.

Caution: Use this trick only for wounds with a low infection risk

In wounds which require high-pressure irrigation, such as contaminated lower extremity wounds or bite wounds, this method may not achieve acceptable pressures.

Corollary Trick of the Trade: “Hair Salon” Irrigation Fluid Collection

To be extra fancy and maintain a dry field, use the “hair salon” technique to collect the irrigation fluid in a plastic wash basin [previous trick of the trade]. Learned from Paul Schneider, a paramedic and one of our best ED techs, a cut a slot for the injured extremity. Padding the sharp edges of the basin provides added patient comfort.


Adam Kaye, MD

Adam Kaye, MD

EM Resident
Beth Israel Deaconess Medical Center
Harvard Affiliated Emergency Medicine Residency
Adam Kaye, MD

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Layla Abubshait, MD

Layla Abubshait, MD

Faculty Development and Medical Education Fellow
Department of Emergency Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
  • Umberto Ucelli

    is there evidence that large volume irrigation beats a few 20 mL syringes ?

    • Mostly expert guidelines and some oldie literature showing that infection rates proportional to volume of irrigant solution. Would tailor volume also based on pretest probability for wound infection risk (less volume for lower risk like truncal or clean, shallow lacerations; more volume for hands/feet especially in diabetic patients or crush lacerations)

      Example of oldie literature. Singleton A, Davis D, Julian J. The prevention of wound infection following contamination with colon organisms. Surg Gynecol Obstet 1959; 10:389.

  • thatguy314

    Volume of irrigation important. So is pressure of irrigation. Would only try this trick (which I’ve used many times) with more superficial or lower risk of contamination wounds. It takes a lot of elbow grease to get high pressure irrigation out of a bottle and most people fail to achieve sufficient pressure to qualify as high pressure irrigation. Not impossible, but unlikely.

    http://www.sciencedirect.com/science/article/pii/S0196064494701598

    http://www.sciencedirect.com/science/article/pii/S1080603216302174

    • Totally agree! We had added a cautionary note under the trick description to help address this but your comments are well worth repeating. Thanks for the links.