NPWT question

[NN2BVE]

I am a nurse at LTC facility where we have a patient with NPWT at a sacrococcygeal site. The wound extends far down close to the orifice and makes it really hard to seal the dressing so it is impermeable to BM. The patient is incontinent and has frequent very soft, almost runny stool that has a tendency to get under the drape. We have to redo the dressing every day and sometimes twice a day. My questions are: 1.Please offer any advise about making the dressing last. 2. Also, are we loosing the benefits of the wound vac therapy because we are not achieving continuous uninterrupted suctioning?

Thank you so much

Inna

[TallRN,WCC]

Hi Inna, wounds in this area with NPWT can definitely be tricky to keep a tight seal. I can try to offer you some advice with what has worked for me in my practice.

Ideally, wound vacs should be left on for 48-72 hours. The fact that you are having to change it twice a day definitely disrupts the benefits of NPWT. I would try using a hydrocolloid dressing (often known as a Duoderm) to create a good seal. This can be used both under and over the drape in hard to seal areas. It adheres better if you warm it with your hands first and can be molded to where you need it to go, like into cracks and crevices. In addition, I have also used stoma paste to create a good seal. This, with the duoderm almost always gives me a seal that will last til the next dressing change.

I hope this helps!

[tamari07]

Agree with the previous poster. We use coloplast to help seal drape around crevices such as the perineum. Also I have used eakin rings to help with seals. Considering the fact that the dsg is contanstly losing a seal and having to be changed twice daily I don't see the patient getting much benefit from NPWT. If they came to our wound center presenting with this issue our MD would see if the patient would benefit from another type of dressing, such as a dakins wet-to-dry. I don't know the patient background or extent of the wound, but we have had patients that needed a temporary diverting colostomy until the wound closes. But much needs to be considered before pursing that option including age, co-morbidities and considering if the wound will actually heal once stool contamination is no longer an issue.

[NN2BVE]

Thank you both for your much needed advice. I will definitely look into eakin rings and coloplast as you both suggested. Since my initial post, the MD did stop NPWT temporarily to let the periwound to heal better. We are resuming NPWT on Saturday and i will be using your tips. Thank you again so much!