When you talk about the 'white foam', are you talking about Versafoam? I use that exclusively for tunneling as it will not pull apart like Granufoam will. We had a situation once where some Granufoam was left behind in some tunneling and new tissue began to grow over it. It had to be debrided out or would eventually abcess. We don't "pack" anything, but make sure that there is a piece of Granufoam over the top and touching so that it will remove excess drainage.
We thin our sponges when indicated. It's not the point of it to be 2 inches above the wound. 99% of our foam is cut in half. Make sure you cut away from the patient and "brush" the foam before applying it to their wound. You should eliminate any "crumbs" that way. All of our cutting is done over the clean table unless we need to trim, which is still done on another table specifically for this purpose.
If a wound needs to be debrided, it's contraindicated in WoundVac. It needs to be debrided before it is applied or it does no good. I've never heard of using anything to debride while the system is running as a) it will get sucked out if it is a cream or b) it will adhere to the Versafoam and cause a barrier.
We don't let any of our patients get the area wet with plain/soapy water. We use only sterile water for each of our procedures and if it's in a pt. that can shower, it must be bagged or covered or else they have a bed bath. You'd have to ask someone else on that one, although we do not let them "loosen it in the shower". Too many places for bugs to get into it. We use No Sting Skin Prep (i think by McKesson) for sealing the tegaderm and also window pane each wound to prevent drainage from seeping underneath. It's been a godsend to do it that way, although KCI doesn't show that on their training video. A knowledgable rep we had tipped me in on that one.
I also use an adhesive dissolver for removal (also made by McKesson but can't remember the name).
Regardless of age, location, depth, etc....WoundVac isn't going to work unless the patient is nutritionally sound. We feed our massive WV's almost like a burn patient, as they need massive amounts of protein for healing. Right now, I'm battling with one that has an albumin of 2.0. Not really conducive with wound healing.
I have a love/hate relationship with WoundVacs. I've seen them work more often than not, but it's soooo time consuming battling those that aren't.