patient question about wound VAC dressings

[miss_mary]

I've had a wound vac for two weeks now, for a dehisced abdominal incision. Originally, I was seeing a wound care nurse that I was referred to by my surgeon, and I was very happy with the care I was getting, and I trusted her level of expertise. Unfortunately, after the first two dressing changes, she had a family emergency and can no longer do my care.

So my surgeon sent me to a wound care clinic, in another nearby hospital.

There are 3 wound care specialists there, and now all three have done one dressing change each, but they all consult with each other, and assist as available.

I don't think they are doing it as well as my original nurse. The machine now continuously gurgles, and they just don't seem to able to get the dressing sealed down right.

They've said they are not familiar with my particular machine (the portable one), and it doesn't seem like they are all that familiar with the VAC in general.

I've been doing a lot of reading about the wound VAC (here as well as other places), and I wonder about a couple of things they are doing.

For one, they cut the foam so that it is sticking out of the wound by a half inch or so, then put another piece on top of that, then the drape and the port.

For another thing, today, the foam was sticking out like two inches, so the nurse took a pair of scissors and cut the foam right there, while it was already in the wound. She cut it down until it stuck out about half an inch, and put another piece on as before. Isn't that a no-no, as little foam bits could get into my wound?

This is not how my other nurse did it. She would very carefully cut the foam to the right size, place it in the wound flush, then do the drape and port.

The are also putting a colloid dressing material on my skin surrounding wound, underneath the drape. My other nurse didn't do this either.

So, are they doing it right? And if not, how do I handle getting them to change their procedure? I don't want to be a jerk, but I also don't want to put up with having my care be less than ideal.

[RN1989]

This forum is for nurses to discuss nursing issues among colleagues. We cannot give medical advice. Please discuss your concerns with your caregivers.

[pressurefree]

I am new to this site and would like to comment on the wound vac. From what I have read in your comment they are using too much foam and adding a hydrocolloid dressing periwound. Actually the company KCI does educate staff on using this technique when necessary. It is not always easy to cut the foam to the exact size of the wound. It is acceptable to cut several pieces of foam and use them providing that they are documented on and you count them when removing. It was explained to me that the purpose of the application of hydrocolloid is to protect the periwound skin. this is not always necessary but does work. I have also added the extra foam to the top of the other piece and this is done when the piece of foam in the wound is not the same size as the disk that you are applying. This is done also to protect the skin because the disk can cause additional problems I have encountered it. It is a tricky process to apply a wound vac when you are not used to working with them.

[traumaRUs, MSN, APRN]

Please consult with your surgeon as we can not provide medical advice. Good luck.

[NRSKarenRN, BSN, RN]

Depending on insurance, most persons with abdominal wounds discharged from the hospital are eligible for home care Skilled Nursing.

We're experts in wound care management and VAC use.

To find visiting nurse agency in your area:

http://www.vnaa.org/vnaa/Searches/findvna.aspx

If none in your area, call hospital where had surgery, ask for case management/discharge planning dept and ask for recommendation.

A WOCN or CETN certified wound care nurse will usually eval and visit patient periodically with experienced staff nurse performing MWF dressing changes. Ask agencies if they have specialized wound care program or WOCN/CETN on staff.

Please inform surgeon not pleased with wound care clinic.

Wishing you speedy healing.