Hibiscrub in wound management

Re: Hibiscrub in wound management

Katie Mansfield — Thu, 31 Jul 2014 07:57:23 GMT

abcaga, I think we might have done the same assignment!!

Re: Hibiscrub in wound management

Krissy — Wed, 30 Jul 2014 17:54:38 GMT

Thanks Mark I completely see your point, it's amazing how clever the body is sometimes, I'd love to show this to her and say 'look see' but sadly some vets only care about is literature and sample size... Not see that patient survived and healed!!! Head..brick wall, I know nothing! I'm JUST and degree nurse who's seen more cases with this issue resolved with no hibi at all!!!! I'll get down of the soapbox now, sorry 4 that every1!!

Re: Hibiscrub in wound management

Mark Hedberg — Wed, 30 Jul 2014 14:55:54 GMT

[quote user="Krissy"]Brilliant that's amazing help thank you every1. sadly the BSAVA wound care manual says the chlorhex can be used to flush heavily contaminated but at 0.05% so at least I've, with your help, made her think about what she's doing with wounds and she's read the paper that, Mark kindly shared the link to. But if anyone finds any further information, I would really appreciate it.

[/quote]

I can see the argument for heavily contaminated wounds, I suppose - after all, if everything else in there is worse than chlorhex, you can make the argument. But I can't see using hibiscrub for routine stuff.

Anecdotally, we had a dog in (many years ago in the Middle East) where the owner brought a dog in for c-section so late that the uterus had burst and the puppies were in the abdominal cavity. Hair and...stuff coated all over the inside. Removed pups, spayed, flushed with ringer (I was out of saline, don't ask) and told the owner to expect the worst. Really, the dog had no chance.

(note: it wasn't the owner's fault, for a change; he lived in a city 4 hours away from my clinic and he trusted a local vet in his city who sadly didn't really know what he was doing, it seems. When it all started going pear shaped the owner jumped in the car with the dog and drove 400km through the desert down to our hospital.)

High doses of antibiotics, loads of fluids (in the veins this time!) and many fingers crossed, the dog made an uneventful recovery. Surprised me, frankly - it was pretty grim inside.

(The short version: this was probably a textbook 'contaminated wound' and I didn't use hibiscrub. I understand that it's anecdote, and sample size n=1.)

Re: Hibiscrub in wound management

Krissy — Wed, 30 Jul 2014 14:13:10 GMT

Sorry it was cloudy whether that shared the link, thank you xx

Re: Hibiscrub in wound management

Krissy — Wed, 30 Jul 2014 14:11:53 GMT

Brilliant that's amazing help thank you every1. sadly the BSAVA wound care manual says the chlorhex can be used to flush heavily contaminated but at 0.05% so at least I've, with your help, made her think about what she's doing with wounds and she's read the paper that, Mark kindly shared the link to. But if anyone finds any further information, I would really appreciate it.

Re: Hibiscrub in wound management

Cloudy Weather — Wed, 30 Jul 2014 09:07:09 GMT

Thanks for that Mark, clearly we need to do a bit of research to as thought as long as povidine-iodine was diluted it was very good to use for cleaning just not lavage. :)

Re: Hibiscrub in wound management

Mark Hedberg — Wed, 30 Jul 2014 08:55:38 GMT

....that's certainly the most unusual formatting i've seen yet on vetnurse! Sorry about that - MBH

Re: Hibiscrub in wound management

Mark Hedberg — Wed, 30 Jul 2014 08:54:16 GMT

[quote]

Louise O'DwyerPosts 10Points 92

replied on

Friday, 09 May 2014 at 20:27

rate this post

Hi Lindsay

Chlorhexidine, and iodine, should ideally not be used in open wounds, as both are cytotoxic. THis is particular important in healing wounds. I generally use Hartmann's as it has a pH closer to that of the local wound environment. And its also the volume of flush which is also important - the minimum I use in any wound would be 500ml

Hope this helps!

Louise x

Louise O'Dwyer MBA BSc(Hons) VTS(ECC) DipAVN(Medical & Surgical) RVN[/quote]

(from the above mentioned thread) Having had the privilege of Louise delivering some of CAW's CPD for many years, I personally will take her recommendations to the bank.

Re: Hibiscrub in wound management

Cloudy Weather — Wed, 30 Jul 2014 08:09:40 GMT

Yes I agree witht he above comments. One of our nurses recently went to a CPD and it appears hartmanns is the product of choice for wounds lavage. I would personally stay well clear of cholorohexidine for wounds,we tend to use dilute povidine-iodine for cleaning and hartmanns for flush.

http://www.scielo.cl/pdf/ijmorphol/v24n4/art25.pdf

This is also from another paper (http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.1997.tb00517.x/abstract):

Results—Sterile tap water significantly damaged canine fibroblasts at all time intervals (P= .05). This was attributed to the alkaline pH, hypotonicity, and presence of numerous cytotoxic trace elements in the tap water used. Cytotoxic effects were noted in fibroblasts after 10 minutes' exposure to normal saline; this may be because of the acidic pH of normal saline and lack of a buffering system. Ringer's lactate did not induce any significant fibroblast injury.

Conclusions—PBS and Ringer's lactate do not induce any significant fibroblast injury, whereas normal saline and sterile tap water cause mild and severe cytotoxic effects in vitro.

Hope that helps :)

Re: Hibiscrub in wound management

abcaga — Tue, 29 Jul 2014 23:14:37 GMT

I did a literature review and from what I read Hartmanns is the best, then saline, tap water. Hibi is very irritant and I hate using it

Re: Hibiscrub in wound management

Krissy — Tue, 29 Jul 2014 22:41:26 GMT

Thanks for your help guys, I was always told Hartmana too, re ph and not even to use saline, but you know how it is, a vet knows everything, so without evidence I'm banging my head against a brick wall.

Re: Hibiscrub in wound management

fairy — Tue, 29 Jul 2014 22:17:33 GMT

I have been told Hibi should never be used for wounds. As mentioned before, this is due to cell damage and it can delay healing.

Re: Hibiscrub in wound management

elaine elder — Tue, 29 Jul 2014 18:44:30 GMT

Hibiscrub contains soap and therefore should never be used in a wound as soap can cause irritation and breakdown. You can use dilute chlorohexidine ( kruse makes a big bottle) or hibitaine without alcohol. This article shows you the dilutions x http://www.ivis.org/proceedings/navc/2006/SAE/528.asp?LA=1

Re: Hibiscrub in wound management

kkatkatk — Tue, 29 Jul 2014 17:49:40 GMT

At my practice we use sterile saline. I have been taught, and read this in many places that as hibi is destructive to living cells so can disrupt the wound healing, that it should not come into contact with an open wound at all and definately not be flushed into one at any dilution rate. sorry i cant point you in the direction of the evidence but i can say you are right to be trying to get your vet to not use hibi in wounds!

Re: Hibiscrub in wound management

Steph Worsley — Tue, 29 Jul 2014 17:41:51 GMT

http://www.vetnurse.co.uk/forums/p/25319/151836.aspx#151836

unfortunately no actual paper backed evidence on there.....but this is a fairly decent thread on the same lines....basically don't use it full stop for wound flushing!