New to wound care.... Several questions

[Kentuckyrn919]

Hi everyone, I'm new to wound care and have a few questions...

1. When cutting foam for a wound vac do you want to cut it to the size of the wound or slightly smaller. I overheard a nurse I work with saying that you want the foam slightly smaller than the wound depth?

2. The other day during a vac change I noticed a significant amount of drainage just sitting in the tubing. The canister was not full and the vac appeared to be functioning well without any alarms. I went ahead and changed the canister with the dressing but I had never seen this before, is this normal?

3. At other wound care clinics do the RNs apply the TCC? The RNs apply them where I work but we do not have the patients sign any kind of waiver. I'm curious how other clinics do this.

4. When measuring irregularly shaped wounds do you still measure length and width at the longest/widest section? I saw a MD the other day who measured a wound as you would a cluster of wounds and measured from the uppermost section of wound to the very bottom section so his length measurement was obviously slightly larger than mine. Hoping that makes sense.

Thanks in advance for any help, it is greatly appreciated!

[oceanblue52]

I'm very new to wound vacs so I'm curious to see others responses. I was taught to cut sponge pretty close to wound with a tiny bit of space around edges. Did you check suction level with canister? If suction is less than optimal that could leave fluid in the tubing. Or maybe a clot? With wounds I always measure the widest area at length and width, but do more detailed charting for depth. So if there is a significant difference in depth between left and right with tunneling or something then I'll chart the 2 different measurements.

[Mistyrose123]

1. when placing white foam in tunneling or undermining you want to place the foam in the undermining and then pull back slightly so that the foam pulls the tissue toward the foam so tissue can close. when placing black foam you do not want the foam to over pack the wound nor underpack. again slight room against wound wall. 2. drainage in tubing: if vac is set to intermittent this will be normal. 3. at my facility I do not apply tcc. 4. when measuring a wound first see what your policy says. typically measure 12:00 to 6:00 for length and 9:00 to 3:00 for width measuring straight up and down and side to side. Hope this helps!

[Eagle2110, ADN, BSN, CNM]

1. I have had physician's instruct cutting the sponge either way depending on the nature of the wound.

2. Misty may be right. I can't say either way because all of VACs are set to constant.

3. RNs do apply TCC at our clinic. Our patient's sign forms consenting to be treated and knowledge of their patient's rights; one right is the right to refuse any part of treatment. TCC is part of their treatment, but of course, they can refuse.

4. May have to look at your facility's policies and procedures. We go from 12-6 for length and 9-3 for width. I attended a training class for my company and heard other nurses speaking against this due to training they've received elsewhere. I have also had physician's go in after nurses and frown upon measurements because they did not agree. I politely say, " Our part is the nursing assessment, completed by a nurse. Feel free to chart your measurements under your notes." ( I know you did not ask for that tidbit, but reading that part made me think of a couple of our docs!)