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[230RN]

Efficacy of Tincture of Iodine ?

XavierBreath:

Many many thanks for your comments!

I can't recommend this since I am not a medico of any kind, but I have found that Tincture of Iodine seems to be very helpful in first-aid treatment of these small punctures.

It seems to me the iodine sort of percolates/penetrates down into the wound and sterilizes it. My observation is that it slows down the healing quite a bit, but I rarely --almost never --get any kind of infection when I slather iodine on one of these minor wounds --pin pricks, paper cuts, pine needles in the foot, some insect bites, etc. (The iodine, an active oxidizer, seems to chemically disrupt whatever irritants are in the bite.)

I also slather it on whenever I have any unexplained itching anywhere. It kind of looks like a nitric acid stain for a while, but it seems to work.

I emphasize that whenever I use this treatment, I don't regard it as a cure-all or a "remedy," and I keep an eye on the wound for a while and will certainly seek more competent treatment if anything goes haywire.

However, I wondered if there were any comments you could offer regarding the effectiveness of Tincture of Iodine in initial treatment of these small wounds.

(When the FDA banned Tincture of Iodine for a while some years back, I found the substitute, an aqueous solution of a complex ammoniated iodine, woefully inadequate. And of course mercurichrome(sp) is banned totally.)

Comments, please?

 

[Lupinus]

I miss mercurichrome. Funny how all the stuff we seem to have banned or forgotten about for the new wonder stuff worked just fine or in some cases better. Give me some mercurichrome and/or Iodine anyday over tripple antibiotic creams.

 

[Ghengis Kahn]

hell, my dad and his buddies played tag with .410 birdshot. They wore Carhart coveralls. Dumbasses :banghead:

 

[XavierBreath]

230RN,
Here is my take on Tincture of Iodine. It will disinfect wounds, but not sterilize them. In my opinion, it is impossible to sterilize a dirty wound without surgical debridement. All wounds outside the surgical suite must be considered to be colonized with bacteria. The real question is not whether the wound is contaminated, but rather how well is the body responding to the infection. It is only possible to prevent even a sterile surgical incision from becoming contaminated for a short period of time. Thus, in my mind, all wounds are infected. Is the infection under control?

Betadine, used for a long time in surgery is a well known antimicrobial, and it works fairly well, except you simply smear dead microbes all over the prepped surface of the skin prior to draping and making the incision. That is why incisable drapes, such as 3M's Inoban have become the standard. They are like a Tegraderm with an iodophor impregnated adhesive, and are stuck over the standard sterile drape's opening to provide a sterile surface all the way to the wound edge.

When it comes to puncture wounds (and only puncture wounds), here is my method, backed up by nothing but my own experience. First, let it bleed, as long as it's not arterial bleeding, or even if it is arterial, as long as it's not excessive. This flushes the wound from the inside out. Anything placed into the wound, even a prep around it to "sterilize" the area runs the risk of introducing more pathogens from the surrounding skin. Second, once it has bled and stopped bleeding (use a sterile compress straight down if the bleeding lasts longer than a few minutes), evaluate the injury using your eyes. Get an Xray to see if there is a foreign object still inside. If you have an intact object that created the puncture, this step can be omitted.

At this point, I like a bit of Inoban stuck over the surface, using sterile technique, to prevent the migration of any more bacteria. Then a small, quarter inch sterile incision through the Inoban to the wound itself, to allow it to drain. If you are going to do a FBR, you must use sterile protocol. Now is the time to do it.

Next, apply a sterile dressing to contain the drainage for evaluation. Dressing changes should be timed to cope with the drainage, or when soiled from outside. They should be performed BID for the first 2 days to evaluate the surrounding area, then QD. Obviously, the protocol for tetanus should be followed as well.

To heal the wound, I rely on the patient's immune system first and foremost. I boost the immune system with high protein, beans, red meat, fish, Omega 3 fatty acids, zinc, multi-vitamins. Those white blood cells are pathogen hit men. Get them going! This is not a time to scrimp on calories. I am not a fan of broad spectrum antibiotics being given prophylactically, but in this case, it's not a bad idea, especially if the puncture was done by a nasty object. I evaluate the immune system's response with a CBC after about 24 hours. If the immune system is not responding well, or if complicating symptoms appear, I do not hesitate to get the Doc to re-evaluate and I want to see changes in the plan of care.

For punctures, that is what I do. For a GSW or other severely tramatic punctures, I will increase the frequency of dressing changes for wound assessment. I assess color, odor, swelling, temperature, pain, and especially the condition of distal tissue and pulses on affected limbs. Compartment syndrome is always a consideration until the infection is under control. I assess the drainage as well as the wound. There is a difference between inflammation and infection. Inflammation is the body's response. Infection is the pathogen's presence. I expect inflammation. It tells me the immune system is working. It is not a bad thing at all.

Some of these protocols deviate from standard, but I achieved very good results using them. I think far too often the thinking is a wound is a wound, is a wound. Wounds are not all alike, each is unique, and each presents unique challenges. I do not treat wounds though. I treat patients.

FWIW, my protocol I have stated here is for punctures that are considered complex wounds. For pin pricks and the like on myself, I just bleed them and watch them. I wash my hands in alcohol each AM as I am in the locker room changing into scrubs. If I have a break in my skin integrity, the alcohol will burn and alert me. I cover the break with Inoban, an Opsite, or Tegraderm and go about my business. This is not a necessary thing for anyone else to do, just a good tidbit for nurses and docs who often deal with infectious diseases and infectious environments.