KCI wound vac question

[Schmoo1022]

Hello,

I wasn't inserviced by the KCI rep, but another nurse that was. I don't think she is doing it right.

She put a tegaderm directly over the wound, then the sponge, then the drain part, followed by another tegaderm? How the heck is the drainage supposed to get thru the tegaderm?

Shouldn't it be the black foan cut to size, then the drain/suction tubing, then a tegaderm?

anyone???

Thanks!

[Lisky90]

The last time I did one, the sponge went directly onto the wound...I believe there was one once that I did that had orders to put gauze and then the sponge on the wound. You are right though, if there is a Tegaderm over the wound it will contain any drainage that the wound vac is supposed to draining. It should be the sponge, the tubing and then there are clear, plastic dressings, like Tegaderm but, made by KCI that go over the whole thing, to create a seal...they are usually much bigger than a Tegaderm.

[cschuess]

When we used the vac we found that we had problems with the black foam and the new granulation sticking to it. Our rep advised us to use adaptic (vaseline impregnated gauze) between the black foam and our problem areas. She also told us that if this continued to be a problem to switch to the white foam. Never had problems after this!

[Ambition13, MSN, RN]

I never heard of Tegaderm over the wound first. We also use the black foam cut to the size of the wound, cut a small slit in the center of it for the drainage/suction tubing, and then the Tegaderm like dressing on top. The Tegaderm on top of the wound is defeating the purpose of the vac, no debriding or granulation will get accomplished that way.

[yumaRN1990]

I am on the wound care team and we never have use tegaderm. We do us adaptic to help proctect the wound bed, especialy if the wound is highly vascular. Then sometimes use the white foam and it is covered with the black. The white is especailly good in tunnelling areas.

[lsyorke, RN]

I am on the wound care team and we never have use tegaderm. We do us adaptic to help proctect the wound bed, especialy if the wound is highly vascular. Then sometimes use the white foam and it is covered with the black. The white is especailly good in tunnelling areas.

Tegaderm defeats the whole concept of the wound Vac. Adaptic, not a problem if there is bad sticking.

[nurse1717]

the type of dressing is largely dependent upon the type of wound being treated (location, type of wound. amt. of drainage, depth, undermining, etc.) in some cases, where there are organs or tendons, adaptek can be placed over the areas (this has a larger weave then tegaderm and will allow for greater granulation) as protection from negative pressure.

again, dressings can vary quite a bit according to the type of wound one is treating. perhaps you can contact your KCI rep to discuss this patient's particular wound/dressing.

best of luck.

[txspadequeenRN, BSN, RN]

i have done many wound vac dressings and the sponge goes on the wound. if you put a dressing over the wound first there is no way for the vac to get a good suction.... humm that is just bizarre.

[iamarn]

I too have had inservice from KCI rep who stated that adaptic was fine to put under foam. Had one pt. that without adaptic it took 3 hours to remove foam due to adherence of foam to wound bed ana painful removal. No adverse affects from using adaptic. wound looks great!

[woundcareRN]

I use KCI's Vac on every wound that is a stage III or higher. I am good friends with the rep and asked her about putting the drape in before the foam. She said NO, NO, NO!!!!! Also if your staff needs trained by kci all you need to do is call 1-800-275-4524 and tell them where you are at and that you need a rep to do an inservice for you. If anyone needs any help with their wounds or has questions feel free to PM me.

[mfk15]

how often should the vac be changed> I was always told 72 hrs. tops.however the place I work is doing it 2x's a week.

[dogmacatma]

THE BULK OF MY WORK AS A HOME HEALTH CARE NURSE IS WOUND CARE. I TRAINED WITH THE KCI REP AND DID FOLLOWUP TRAINING WITH OUR AGENCY WND CARE SPECIALIST RN, AND HAVE SINCE DONE MANY, MANY WOUND VAC TREATMENTS, AS WELL AS ASSISTING IN TRAINING OTHER NURSES IN THE TECHNIQUE. WHAT MAY HAVE HAPPENED WITH THE USE OF TRANSPARENT DRESSING (TEGADERM) SUPPLIED WITH THE KIT IS THAT THE TRANS DSG WAS INDEED APPLIED OVER THE WOUND, USUALLY WITH THE AID OF SKIN PREP AROUND THE WOUND SITE. THE TRANSPARENT DRESSING IS THEN CUT AWAY FROM THE WOUND ITSELF, FOLLOWING THE WOUND EDGES, BUT LEAVING SURROUNDING SKIN PROTECTED. WE USE SMALL SCISSORS WITH AN UPCURVED BOTTOM SO THAT THE PATIENT IS NOT INJURED CUTTING AWAY THE TRANS DSG. AFTER THAT A NUMBER OF OF OPTIONS ARE USED, DEPENDING ON WHAT IS APPROPRIATE FOR THE PATIENT. ADAPTIK OR WHITE FOAM MAY BE USED TO PROTECT THE WOUND BED, THOUGH WE OFTEN TRY BLACK FOAM ALONE INITIALLY. THE FOAM SHOULD TOUCH THE WOUND ONLY, NEVER HEALTHY TISSUE, AS DOING SO DAMAGES THE HEALTHY TISSUE. AFTER THE FOAM IS CUT TO WOUND SIZE AND APPLIED, IT MUST BE COVERED WELL WITH ANOTHER LAYER OF TRANSPARENT DRESSING WHICH COMPLETELY COVERS THE FOAM AND EXTENDS BEYOND THE FOAM, ADHEREING SMOOTHLY AS POSSIBLY TO ENSURE A GOOD SEAL. A HOLE IS THEN CUT, ABOUT THE SIZE OF A NICKEL. THE ADHESIVE IS REMOVED FROM THE BOTTOM OF THE WAFER WITH THE DRAIN ATTACHED AND PLACE OVER THE HOLE. I FURTHER SECURE THE WAFER WITH A BIT MORE TRANSPARENT DRESSING. THIS HELPS ENSURE IT ISN'T PULLED OFF WITH THE PATIENT'S MOVEMENT. OK, THAT'S KCI. WE ALSO USE SMITH AND NEPHEW AT TIMES, WHICH REQUIRES A DIFFERENT TECHNIQUE REQUIRING LESS TRANSPARENT DRESSING, AND USUALLY, BUT NOT ALWAYS, GAUZE INSTEAD OF FOAM. WOUND VACS SHOULD BE CHANGED EVERY OTHER DAY, THOUGH IT IS USUALLY ACCEPTABLE TO SKIP 2 DAYS A WEEK, AS ON THE WEEK END. I DEAL WITH MANY WOUND CARE MD'S AND ARNP'S AND DONT BELIEVE THIS HAS EVER BEEN UNACCEPTABLE TO ANY OF THEM.