Pressure ulcer is among the most common causes of long term morbidity in patients with spinal cord injury and the leading cause of hospitalization for such patients. The cost of treatment per patient ranges from $2,000 to over $120,000. Pressure ulcers can lead to other complications like local tissue infection, sepsis or amyloidosis. Hydrotherapy is one of the two specialized treatment modalities recommended for wound healing. The two types of hydrotherapy include whirlpool therapy and pulsatile lavage therapy.
Pulsatile lavage treatment uses a pulsatile pressurized stream of normal saline to provide localized hydrotherapy to pressure ulcers. The treatment employs a single patient use device, which has a disposable tip for every treatment. This reduces the likelihood of cross contamination.
A study to determine the efficiency of low-pressure pulsatile lavage treatment for stage three and four pressure ulcers in patients with spinal cord injury was conducted. Both the participants and the assessors were not aware of intervention assignment. The Participants were divided into a treatment and a control group randomly, with the awareness of the research nurse only. The participants got selected through strict criteria. Out of 267 inpatients with SCI, only 28 met the criteria and participated in the study. Of the participants, 11 had sacrococcygeal pressure ulcers, 15 had ischial pressure ulcers, and 2 had buttock area pressure ulcers. The treatment and control group each had 14 patients. In the treatment group, 7 participants had sacrococcygeal ulcers and 7 had ischial pressure ulcers. In the control group, 8 had ischial pressure ulcers, 4 had sacrococcygeal ulcers, and 2 had buttock area ulcers.
Participants in the treatment group received low pressure pulsatile treatment and the standard wound care protocol. The control group received sham treatment and standard wound care protocol. A Stryker Interpulse System was used. It is battery powered with, a portable handheld pump, which produces low pressure jets of fluid in pulses. The source of fluid was a 1 liter bag sterile normal saline at room temperature. The study personnel wore protective garments to prevent splash injuries. The saline was applied to the pressure ulcer through a fan shower spray for 10 to 20 minutes. Both groups received treatment for 3 weeks, with dressings removed before starting every treatment. The nurse, unaware of the group treatment, measured all the outcomes. The results evaluated included changes in wound size, wound volume, and wound depth.
The results of the study showed that wound measurements in the treatment group reduced more than the control group. Therefore, low pressure pulsatile lavage treatment and standard wound care protocol were effective for the treatment of stage III and IV pressure ulcers treatment. Pulsatile lavage treatment enhanced healing through mechanisms such as mechanical stimulation, wound bed vascularity increase, a decrease in bacterial load, and negative pressure from the device. The previously used high pressure lavage caused deeper penetration of bacteria into the wound.
Pulsatile lavage treatment is low cost. However, it is not recommended for patients with chronic pressure ulcers. Wound measurements are applied in clinical practice since it is cheap, easy to use and apply. Irregularly shaped wounds lead to errors in measurements. Volume measurements using saline can be accurate since it involves filling the three dimensional wound cavities. The position of the wound and absorption of the saline determine the accuracy of volume measurement.
Bogie, K. M., Wang, X., Bensitel, T., & Ho, C. H. (2012). Pulsatile Lavage for the Enhancement of Pressure Ulcer Healing: A Randomized Controlled Trial. Ohio: American Physical Therapy Association.
