long story here, but mainly i'm having a hard time swallowing what was done at a patient's bedside the other day, and i'm loosing sleep over it!here's the gist:
bad trauma (opening ICPs over 130, ICPs maintained in 80s-90s despite treatment) needed a wound vac to abdomen. to "save costs" the surgeon rigged up his own wound vac at bedside with a sterile towel in the cavity, two OG tubes in the space, your typical occlusive dsg over top, and hooked the OG tubes to a sump pump. will this save costs? sure. was the procedure sterile? yes. will this be effective treatment (in a long term sense)? i don't think so.
now, maybe his reasoning was that we simply needed a quick fix, and this pt was sure to die or have care withdrawn soon. i guess i can accept that. but if he's going to be doing this sort of thing routinely, on pt's that are expected to live - even if it is just temporary - i don't think i can stomach it. i think even a short time of having that fibrous (cotton) material in a wound bed is dangerous and sets up a bad cellular environment for more inflammation, greater risk of infection, decreased healing, and increased chance of adhesions forming later on. i base these assumptions on both common sense and on the fact that i have a masters degree in cellular and molecular biology, so understand a few things about cell/tissue behavior and signaling. i've only been a nurse, however, for a little over a year, so maybe i don't fully understand some of what his thinking was, beyond a quick/temporary measure that saved lots of money.
has anyone else seen this sort of thing? am i worrying too much? i feel like i should discuss this with my nurse manager. thanks