Frustrated

[MendedHeart]

Scenario:

Post-op day 6 from a midline abdominal wound debridement. Wound vac in place since surgery. Pt to be discharged to SNF. Wound vac removed and wet to dry placed until pt arrived to SNF. Wound started bleeding pretty good after wound vac removed. Discharge cancelled, wound vac reapplied.

I came in for night shift, and wound was bleeding out around vac. MD was notified. He was told it is bleeding quite a bit and pocketing under vac drape and that protocol was to remove.

He wanted to keep it on, and for me to keep changing it. H & h 9.5 and 29 at this point.

The vac clogged, the wound continued to bleed regardless of what I did.

I called the MD back a few hours later to let them know it was still bleeding and a was unable to keep the vac on. They ordered a CBC and Type and screen and told me to reapply the vac again. If it doesn't work, then place wet to dry.

I replaced it, and about 20 minutes later, it was clotted again. I placed a pressure dressing and H & h came back at 8 and 28.

Pt was stable even though bleeding continued, so when 5 am labs came back and H & H came in at 6.9 and 21, I called the MD back. Order given to transfuse 2 units prbcs.

I came back the next night, pt was in unit. Apparently the MD told several staff on my floor and the ICU that we were incompetent at wound vacs and we didn't know what we were doing.

So frustrated with the MDs behavior

errrrrhhhhh

[Here.I.Stand, BSN, RN]

I wonder why it kept clotting off? Was the foam getting sucked down, or were there any indicators of a poor seal?

But the pt would have needed the transfusion either way -- the blood was exiting vasculature for the hgb to be dropping like that.

Telling other shifts/units yours was incompetent at wound vacs, though? Unprofessional. If he has a concern about competency, he should have approached your NM about getting the staff better trained.

[MendedHeart]

It's always has a good seal immediately but after several minutes the tubing started getting clogged with clotting blood and blood was pooling in large pockets under the drapping. I wonder if it was doing that because of the amount of blood that was coming out.

I was and am very frustrated with the MDS behavior. Not only because my floor and myself get vacs often and have annual training but because like 2 other nurses were helping me and they had tons of experience and I worked hard in that room ALL night.

[Libby1987]

Negative pressure is contraindicated with bleeding. Sero sang is one thing and in that case I would have put down a contact layer and maybe reduced the pressure but bleeding, no way.

[MendedHeart]

I'm with you. I felt uncomfortable with it from the start of shift.

[loriangel14, RN]

You cannot use a vac dressing if it is actively bleeding.