Mediastinal irrigation solutions


Saline or Hartmann's are probably as good as any mediastinal irrigation - the main function being to keep the drain from blocking.

Also see pleural window lavage solution (Betadine, Hydrogen Peroxide)


  1. Neomycin Sulphate 1gm

  2. Bacitracin 50,000u/s

  3. 1000cc 0.5 Normal saline at 50-100ml per hour (Jamplis RW and McFadden PM in Shields Textbook)

Povidone Iodine

(Betadine is a 10% solution Povidone Iodine)

  1. Povidone Iodine 0.5% (1:20 dilution) soaked in sponges (Shields, also Deschamps et al Chest Surgery Clinics of North America, Aug 1996)

  2. Povidone Iodine 2.5% (i.e. quarter strength Betadine antiseptic solution) as irrigation. (Mathisen in Current Therapy in Cardiothoracic Surgery, Grillo et al, published by BC Decker 1989)

  3. Anaphylaxis has been described

Dakin's Solution

  1. Dilute sodium hypochlorite as soak in sponges for open sternotomy or empyema wounds

  2. Modified Dakin's solution 0.025% sodium hypochlorite

Urokinase/streptokinase for empyema/loculated effusion

  1. Urokinase 250,000U in 250ml

  2. Instill 80-150ml aliquots

  3. Clamp drains for 2 hours (Lee-Chiong TL et al, in Chest Surgery Clinics of North America, Aug 1996)

  4. Alternatively 1000 - 2500 u/s in 100 - 500ml NS with dwell time 30-180 minutes (Moulton JS et al AJR 1989)

Urokinase is still available (2001) but is hard to source. Streptokinase is easily available and would seem, on limited experience, to be similar in performance. The same regime can be used substituing 250,000 U of Streptokinase for the Urokinase.

DAB's solution (Mayo Clinic - for packing more than irrigation e.g. Claggett procedure):

  1. per litre normal saline

  2. neomycin 0.5gram

  3. polymixin B sulphate 0.1gram

  4. gentamicin 80mg

Axiom drains

Axiom drains - with a second channel to a Luer lock originally designed for intrapleural analgesia can be used to continuously infuse irrigation without disconnecting the chest drain.

Available from:

AXIOM Medical Inc.

555 West Victoria Street, Rancho Dominguez CA 90220

Phone: +310-898-1779

Fax: +310-632-1326