Friday, February 1, 2013

Don't Waste the Saline

This is a study that follows-up and confirms the prior "mythbusting" literature regarding the management of minor soft-tissue lacerations in the ED.  Specifically, this article evaluates the need for wound irrigation with sterile saline ($) as compared with tap water (free).

Unsurprisingly – and consistent with prior literature – this relatively contemporary study of 663 patients at Stanford University hospitals shows no difference in subsequent rates of wound infection, regardless of irrigation solution.  The sterile saline group suffered 6.4% (9.1 to 3.7%) subjective wound infections in follow-up, compared to 3.5% (5.5 to 1.5%) infections in the warm tap water irrigation.  A few patients were lost to follow-up, and the study has some generalizability limitations due to predefined exclusion criteria – frequently seen ED comorbidities such as diabetes, alcoholism, and immunocompromise were excluded.

But, it's another piece of the puzzle that tells us suturing of uncomplicated wounds needs not be made more complicated.  There's no evidence to suggest that anything more than tap water, absorbable sutures, and non-sterile techniques are needed for optimal patient outcomes.

"Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial"
http://bmjopen.bmj.com/content/3/1/e001504.full

3 comments:

  1. This is highly interesting considering the costs & resources put into a simple problem coming to the ED with high frequency.
    I heard about saline vs tap water a few years ago but non-sterile techniques is new, could you please provide link?

    Regards,
    David

    ReplyDelete
    Replies
    1. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial.
      http://www.ncbi.nlm.nih.gov/pubmed/14985664

      Delete
  2. Excellent, thank you.

    Now let's see if we can put this into practise!

    -David

    ReplyDelete

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