**6. Unblocking the irrigation system**

At any given time, the irrigation system can be blocked. This can be observed during drainage times. When the yellow clip is opened there will be no movement of the fluid from the patient to the bellow. A bellow is supposed to provide a continuous negative suction pressure at all times but this would be disturbed due to various reasons. Those reasons might be after physiotherapy, after mobilizing to the bathroom without taking precaution in the handling of irrigation system or a blood cloth or fat debris from the bone marrow caught between the outside tube (the tube that drains the irrigation fluid from the patient) and the intra-catheter (the inner tube that administers antibiotic to the wound site).

Before trying to unblock the tubes, the system should be checked if it is still in situ, as the system is only held by one stitch around the insertion area, it is easy for tubes to come out. Once the tubes are out, the whole system must be removed. They must never be pushed back inside the patient as this is a sterile procedure done in theater, so pushing the irrigation system in the patient's wound would be introducing infection to the patient as those tubes would already have been exposed to the unsterile environment.

Another thing that a nurse can do to maintain the continuous negative suction is to open a blue or white clip between the bellow and a drain bag (That looks like a urine bag but without the volume markings) and then put pressure on the bellow until all the contents of the bellow have been drained to the drain bag. If the drain bag is full of air from the bellow, the air can be released without contaminating the system. If the bag is full of fluid drainage it can be emptied and discarded. There is no need to measure the contents of the bag.

If putting pressure on the bellow is not working a 20 ml syringe can be used as the same procedure of taking a specimen to try and provide manual suction. This can be done several times if the patient is complaining of pain. The clot; unless it is not big might come and may be seen in the syringe after being caught. The port must be closed and then the two pinch clamps (the red and yellow one) must be open to check if there is any drainage. If the clot was properly removed, the system might be seen running properly at this moment.

If those two avenues have been exhausted it could mean there is a clot somewhere that could not be removed with a mere 20 *ml* syringe. A 50 mg of Actilyse (alteplase) should be mixed with 50 ml of sterile water for injections. After that 2 *ml* of that solution should be added to an already prepared new solution of 50 *ml* sodium chloride and a relevant antibiotic. The 2 ml of alteplase solution should not be added to an already running antibiotic. A new solution must be prepared and an old one must be discarded so that 2 mg of actilyse is added into 50 ml of sodium chloride with for example 1.2 g of Augmentin.

Streptokinase 1,500,000 international units is another drug of choice in the unblocking of irrigation systems depending on the hospital pharmacy availability. It also should be added in 50 ml water for injection and 2 ml withdrawn and added into the antibiotics.

Two cycles of irrigation procedure should be enough to clear any clot and the solution should be removed unless the problem is persistent. The patient should also be

*Lautenbach Irrigation System DOI: http://dx.doi.org/10.5772/intechopen.103078*

monitored for any bleeding on the wound site. The solution should be discontinued if the bleeding is concerning or if it is disproportionate to the amount of antibiotic solution administered.

Sometimes the irrigation system will stop running and restart during the next cycle on its own without any interference from the nursing staff. The assumption is that there might be nothing to drain from inside especially after taking a specimen. Remember +/− 40 ml is taken during specimen collection and during the administration of antibiotics only 20 drops are administered, which is not a lot by any account.
