Dr's using negative pressure devices (vac's) on closed surgical incision

Specialties Home Health

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Specializes in Hemodialysis, Home Health.

I have been a home health nurse for 4 years now, and today I had a pt come home from hospital with a closed surgical incision that was cellulitis and abscess, closed with sutures, very minimal space open, no drainage. I have only seen this ordered one other time, and I will tell you it was a disaster, pt ended up back in the hospital for wound infection d/t wound had enlarged. Called the surgeon, he states do as ordered place device over si because this is for lymphatic drainage. The dme company stated they were under the impression that the wound was open, not closed, and that this is not a normal practice for negative pressure devices due to the fact that it does indeed cause a new/worse wound in most cases. Just curious if any of you all have heard of md's ordering this treatment for closed si's related to cellulitis and abscess. Very frustrating for me and the pt.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

I've just come off wound vac due dehiscence. :)

Plastic surgeon + WOCN discussed this was being used by some docs post op for patients at high risk for dehiscence + ongoing incision drainage --it is different vac from one to close wound, used for up to first 7 days.

Info:

KCI Prevena, the first powered negative pressure wound therapy product, is designed for management of closed surgical incisions.

Clinician instructions

Indication for Use

The Prevenaâ„¢ Incision Management System is intended to manage the environment of surgical incisions that continue to drain following sutured or stapled closure by maintaining a closed environment and removing exudate via the application of negative pressure wound therapy.

Optimum Use Conditions

For maximum benefit the Prevenaâ„¢ IMS should be applied immediately post surgery to clean surgically closed wounds. It is to be continuously applied for a minimum of two days up to a maximum of seven days. It can transition home with the patient; however, all Prevenaâ„¢ Dressing changes should be performed under direct medical supervision.

The Prevenaâ„¢ IMS will not be effective in addressing complications associated with the following:

•ischemia to the incision or incision area

•untreated or inadequately treated infection

•inadequate hemostasis of the incision

•cellulitis of the incision area

The Prevena™ IMS should not be used to treat open or dehisced surgical wounds or on patients who have excessive amounts of exudate from the incision area which may exceed the Prevena™ 45 mL Canister. The V.A.C.® Therapy System should be considered for treatment of these wounds.

The Prevenaâ„¢ IMS should be used with caution in the following patients:

•patients with fragile skin surrounding the incision as they may experience skin or tissue

damage upon removal of the Prevenaâ„¢ Dressing

•patients who are at an increased risk of bleeding from the incision due to anticoagulants or platelet aggregation inhibitors.

CONTRAINDICATION

  • sensitivity to silver

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Specializes in OR, Nursing Professional Development.

There are actually vac dressings intended for use with closed incisions- KCI's Prevena comes to mind. A bit more pricey, but at least it can be used as intended.

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Specializes in Hemodialysis, Home Health.

Glad to hear about the kci prevena, this particular pt did not receive that particular brand of vac. Dr did not specify which brand pt needed or type of dressing in particular. I will mention this to surgeon. Thanks so much for the info. :up:

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Specializes in Hemodialysis, Home Health.

Thanks for the great info!

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

A review of evidence and mechanisms for an emerging indication

Abstract

Objectives

The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT).

Methods

We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail.

Results

A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action.

Conclusions

There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement.

Cite this article: Bone Joint Res 2013;2:276–84.

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We have an orthopod in our group who uses a wound vac on closed incisions if he feels like it is indicated. He is pleased with the results so far.

don't feel alone not being used to it OP. He gets calls on it from home health nurses at least weekly.

I am going to get him a copy of the article from NRSKarenRN so he can attach it with the order to cut down on calls. Thanks for the great info.

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We have an orthopod in our group who uses a wound vac on closed incisions if he feels like it is indicated. He is pleased with the results so far.

don't feel alone not being used to it OP. He gets calls on it from home health nurses at least weekly.

I am going to get him a copy of the article from NRSKarenRN so he can attach it with the order to cut down on calls. Thanks for the great info.

I remember my first one, I had to call, I had no idea if I was supposed to do anything with it. Instructions would have been helpful.

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