Bridging 2 stage 4s with wound vac

[holistic1028]

I currently have a home health case to apply wound vac. This patient has 2 stage 4s.. 1 to upper sacral area and the other to lower left ischium. I am new at bridging and it seems like I keep getting a leak, not a constant noise but intermittently every 10 seconds or so.. I've pressed every area and still can never find it. The patient gets frustrated and says to just forget it, she'll deal with the noise so I end up leaving (almost an hour and half later) feeling incompetent and unsatisfied with my work. These are the steps I take:

Remove old wound vac drapes and tubing,

cleanse area

measurements etc.

spray peri wound areas with no sting barrier film skin prep

measure and cut granufoam to fit inside each wound (I think this is my problem area because I've been told to make sure theres enough foam to completely fill wound and I've also been told to make foam slightly smaller than wound)

cut tegaderm strip to cover both wound with foam #1, cut another to cover wound with foam #2

Then I cut opening to tegaderm over each foam

Next I cover skin with tegaderm where bridging will be (one vertically inbetween each wound and another off to the side where I plan to apply suction) Confusing huh

Then I put foam bridge on top of both openings (which is hard because the foam is curled) and I put another foam as close to or on top of the bridge to extend it out (the bigger round part of the foam)

Apply tegaderm on top of all of this (which is hard because it moves) So i do it in strips

Cut hole in extended bridge and apply suction there

What am I doing wrong? Any tips? Most videos only show how to do one wound but I havent come across any online on how to do 2 wounds and bridging them together.

[woundnurse4u]

I feel your pain! Thank you for offering such detail as to how you are applying the dressings. In these cases (and I have had a few of them), I will sometimes do one dressing at a time. For example, apply the upper sacral dressing and bridge to the side FIRST. Connect the tubing to the machine and turn it on. This should allow you to see that this site is a GO or not. Then apply the dressing to the ischial wound and create the bridge between the sacral wound and the ischial wound. Before creating that final cut into the sacral dressing for the bridge turn the VAC off and seal that bridge. Then turn the VAC back on. By using that technique, I can better locate seal leaks if I know that one wound checked out A-Okay already as far as integrity.

With that being said, I do not like my wounds to "talk" to each other (ie drawing drainage from one wound into another wound during bridging). I tend to bridge each wound over to the side so the bridges have a

[holistic1028]

Great idea! and makes much sense. I will try this next time I do it. Thanks for your response

[Lee J A]

It sounds to me like you are doing everything right. What type of skin prep are you using? Any wrinkles? I think the Cavalon prep works best. After you apply you can again go over the edges with the skin prep and over any wrinkles. So before and after application. I got this tip from a kci rep. Those reps have lots of good tips so I would call your rep for advise as well.

[anh06005, MSN, APRN, NP]

I thought the foam should at least fill the wound (or maybe be a little higher than skin level). It's what I did so when the suction is applied and sucked down the foam always touched all areas of the wound bed. If you window pane there's no risk to healthy skin even if it overlaps a little.

Or was I doing it wrong? Lol. I didn't do many wound vacs unless the wound nurses were off so I just got them through to the next visit

[RNtraveler2014]

how did everything go with your VAC???