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CHAPTER SEVENTEEN: Pulsed Lavage with Suction

Karen A. Gibbs, PT, PhD, DPT, CWS; Rose L. Hamm, PT, DPT, CWS, FACCWS

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

  1. Describe the mechanical effects of pulsed lavage with suction at the cellular and tissue levels.

  2. Select patient situations when the use of pulsed lavage with suction might be indicated.

  3. Relate advantages and disadvantages of using pulsed lavage with suction for wound healing.

  4. Apply precautions associated with the use of pulsed lavage with suction for wound management.

  5. Follow infection control precautions during treatment using pulsed lavage with suction.

INTRODUCTION

Pulsed lavage with suction (PLWS) is a portable, battery-powered, handheld device utilized by physicians, nurses, and physical therapists to promote wound healing. The two primary components of PLWS are (1) the pulsed delivery of sterile irrigation fluid onto the wound surface and (2) the simultaneous suction and removal of contaminated irrigation fluid and wound debris (FIGURE 17-1). The combination of pulsed lavage with concurrent suction has been shown to be beneficial in wound healing.1 Literature supports the use of PLWS for wound cleansing, removal of topical agents, irrigation, mechanical debridement, reduction of surface bacteria, and stimulation of cells associated with tissue healing and wound closure.2,3,4

Figure 17-1

Components of pulsed lavage with suction Irrigation fluid flows from the irrigation bag, through the tubing, into the handpiece, and through a central opening in the tip. As it is pulsed onto the wound bed, the contaminated fluid is suctioned through a concentric outer opening and into the tubing that goes to the suction canister. Setup of the equipment includes proper connection of all the tubing ends into the bag and the canister!

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PLWS has been utilized in health care for decades beginning in the 1960s when US Army physicians first adapted modified WaterPik units for the irrigation of contaminated combat wounds.5,6,7,8 The original units have been advanced to the light-weight portable units that are currently used in both surgical irrigation and wound management in in-patient, outpatient, and home health settings.9 The gun-like shape of the handpiece makes the device easy to grip and maneuver and an assortment of tips adapt to different wound sizes and locations (FIGURE 17-2). While different vendors (BARD Davol, Inc, Warwick, RI; Stryker, Kalamazoo, MI; Zimmer, Inc, Warsaw, IN) market disposable PLWS units with different options, the basic equipment requirements are essentially the same (TABLE 17-1).

Figure 17-2

Photo of handpiece The pulsed lavage handpiece pulses sterile saline solution into the wound with a controlled psi and suctions the contaminated fluid into a closed suction container. Note how the therapist’s fingers are used to maintain good contact of the tip with the tissue. This helps prevent spillage and aerosolization of the fluid and directs the flow of the solution ...

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