Wound vac question/vent - page 3
by Nursetastic 9,941 Views | 24 Comments
I'm a new grad with very little experience with wounds, so I have a situation that confuses me. Am I just experiencing newbie jitters or am I legitimately concerned? The nurse orienting me told me she'd never seen this before... Read More
- 0Feb 12, '13 by HM-8404I don't mean to derail this tread but I have a wound vac question. When is a wound vac not appropriate? In my last clinical there was a pt with the worst wound I have ever seen, and I have been in a trauma ICU. This pt has an open wound from about L3-L4 to his perineum, and from R iliac to L iliac, with everything exposed. When the dressing was removed I thought maybe this pt had been hit by a car and drug underneath it removing all of the flesh and most of the muscle tissue. I found out later it was a pressure ulcer that was not taken care of properly. The pt has an ascending colostomy and his colon is just hanging there like a hose.
The pt was A&O x3, helped with own care, etc. I got busy and never had a chance to ask why this pt did not have a wound vac.
- 0Feb 12, '13 by tyvinMany times wound vacs are indicated but it's the insurance that stands in the way...especially if you have the patient at home. Maybe things have changed but it's my understanding that all the wound vacs are owned by 1 company and they don't sell them (show me the money!). So you have a monopoly. Many insurance companies will let patients go home with them but some don't. That's the reason I see that patients aren't put on wound vacs because they're at home and insurance won't approve.
- 0Feb 12, '13 by beckster_01Would the patient have been stooping into the dressing frequently? As the previous poster mentioned, VAC's and their supplies are expensive, and if it would have to be changed frequently, or if it is going to be in a dirty area, then the coat-benefit isn't worth it. They are also indicated for healthy wound beds. Often they will be placed after debridment. But they won't do any good over eschar/slough.
- 0Feb 12, '13 by DookieMeisterRNQuote from NursetasticI have seen vacs placed over sutures before. It sounds like this is not your typical patient and that other measures have failed in the past but it used to be that wound vacs were contraindicated for osteomyelitis. But there are atypical cases like this that may benefit from this treatment. The best people to ask would be the surgeon and/or ID doc!I'm a new grad with very little experience with wounds, so I have a situation that confuses me. Am I just experiencing newbie jitters or am I legitimately concerned? The nurse orienting me told me she'd never seen this before either but that couldn't hurt.
We had a patient come in today for wound care on both sides of her foot and her surgeon had placed a wound vac over sutures. She has MRSA in the wound, and possibly in the bone (all following arthrodesis over 6 mos ago), and has had numerous I&D's (including one a couple weeks ago, hence the sutures that are for some reason still there) and at one point the wounds were apparently gaping, deep, tunnelled and had "benefited" from the wound vac before. I've never seen a wound vac on top of sutures...is this something that you have seen before? The wound drains A LOT even through the sutures and when we removed the sponges it just drained like a faucet the whole time. Oh, and she is no longer on IV ABX, just oral bacitracin, so I'm sure the MRSA is still raging under those sutures.
I'm venting, so I'm sorry if my post is confusing. Wound care really fascinates me and this situation seems odd. The patient is followed by bother her ortho surgeon (at our clinic) and an Infectious Disease doc.
- 0Feb 12, '13 by kciccSo that sounds like a terrible wound of course and likely a difficult dressing change no matter what is being used. If this pt is in acute care, often times I have seen wounds like these NOT vac'd as the perception is that it would be impossible to get a seal, too time consuming etc. However, a couple of tips and these "impossible"wounds can be VAC'd too. Colostomy done, so we don't have to be too concerned w/ that. If sphincter is still in place, that should be covered with white foam or adaptic as should any exposed vessels, organs etc. The XL dsg is great for irregular shaped wounds as it is seamed/serratted and more mold able. So the secret here in addition to plenty of skin prep and 4X4s is an O2 extension tube! Connect the tube to the O2 and crank it to 10-15L! You can now use this to spot dry the skin as you are applying the drape. This simple technique has been used on some pretty complex nec fash wounds that were very moist/wet. Take your time, plan ahead, apply the drape in strips and it should work. If not for this pt, maybe the next. Believe me, you'll be everyone's hero!