goodasitgetts

You do not need to cut the foam to fit the wound if the surrounding skin (the periwound skin) is protected. You can do this by peridraping or covering the surrounding skin with vac drape. The easiest way to accomplish this is to put a piece of vac drape over the wound, then cut out the portion over the wound. Then put in the sponge. This method is also used for bridging (connecting more than one wound close together). Your vac rep can give you more info on this technique. The vac sponge can also be split to make it thiner using a disposable scapel or a thin version can be ordered if needed. Trust me, I teach these techniques to nurses daily as I am the hospital WOC nurse. Once again, your rep is your best resource! If you don't know who your rep is you can find out by calling KCI at 1-800-275-4524.

One of the things that I have always liked about home health is that HH nurses are some of the nicest nurses I have ever worked with. How many times have we picked up medications at the pharmacy, shoveled snow, or purchased items with our own money for our patients in need? There are a lot of "users" out there and they know us when they see us! As a 12 year HH veteran I have been manipulated many, many times! Remember that this type of person is used to living off others. Before I do anything I stop and think about whether I am actually helping the person or making them dependent. Remember the old adage about teaching a man to fish rather than giving him fish so that he can feed himself for the rest of his life. Some tips on how to tell when a patient or family is trying to manipulate you-pay attention to the patient's home. Do they have old HH folders lying about from past admissions (may be knowledgable of how to manipulate the system), have you noticed them trying to manipulate someone else such as a neighbor in front of you? Does the patient have a chronic and long-standing disease and act like he doesn't know how to take care of himself (likely many have tried to teach him, people with long-standing chronic diseases can be very manipulative) Does the patient have a psych history or does he take more than one psych med (may have psych problems), is the patient evasive about giving history? Do the supplies left in the home disappear? Does the patient seem to be using a lot more supplies than he should be using? Is the patient demanding about what time of day you see him (may be hiding the fact that he is not home bound, obviously manipulative). Does what he tells you seem suspious (a patient once told me that he could not walk, never got out of his chair yet couldn't explain how he got to the toilet or how candies got next to his chair). Try doing a safety assessment of the patient's home (we should be doing this anyway). I once found that the patient who badly needed dressing supplies for his wound had more dressing supplies in his back bedroom than we had at our nursing agency! One type of manipulation that we frequently run into is the patient we "cannot" do his wound care. Ask yourself can he reach the area (if the wound is on his foot, can he put on his shoes and socks?), could he do the wound care if a mirror is used? If a patient needs some type of supplies frequently there are local agencies where the patient can get the help he needs. Remember that our goal is make the patient independent so our actions should be towards that end.

I have been a nurse for 16 years and I think that you handled that well! FYI- in the future if you EVER think that you are in danger while dealing with a patient you have the right to stop what you are doing and ask for help. I have seen nurses who were severly injured by patients and I know of an instance where a nurse who was actually raped by a patient during night shift! That is why hospitals have charge nurses and security guards. Your safety is important! One more thing- you should have at minimal documented what occured or requested that it be documented. Patients like that frequently are abusive to many staff but if it isn't documented than if is difficult to prove in case an incident occurs. Best wishes!

THe vented pouchs have a charcoal filter over the vent which helps to prevent odor. You must be careful to keep the filter from getting wet or it won't help with the odor. Some have changeable filters as well.

I started as a burn nurse, then moved up to burn ICU. After about 5 years I started feeling stressed and moved into home care. I loved doing home care and I quickly discovered that I knew a LOT more about wounds, grafts, and flaps than most of the other nurses. I decided to become a WOC nurse after a few years of working closely with the WOC nurses. They were about the nicest and most knowledgable nurses that I had ever met. I announced this to my supervisor who promply offered me a position as an "assistant" to our WOC nurse who was very overwhelmed as we had hundreds of patients in service and she was the ONLY woc nurse. I worked one on one with her for six weeks and received a wonderful education! Later on she would ask me to meet her whenever she had an interesting case. The one thing that was most helpful was working around people who had more experience and were willing to share. Other things which proved helpful were seeing the same patients over and over and watching their progress and learning what was helpful and what was not. Working in a wound center should be helpful but make sure that you are working with at least one practioner who has had formal wound training. There is a wound center nearby were some of my (home care) wound patients receive treatment. The nurses at that particular center have no training and frequently do not practice what is known as "evidence based practice." This means following established protocals which are based on research and common sense. If you know a WOC nurse or have one who works at your facility you may try speaking with her and asking her if she would help you on your quest. She might be very willing to assist you. I am always willing to assist fellow nurses. I need them as much as they need me! Good Luck!

I suggest that you talk to your head nurse and talk to her about how you feel. Nobody should be asked to work with a wound vac without some instruction. It isn't fair to you or the patient! The head nurse can contact your WOCN nurse and request that she spend some time with you (or your unit) for instruction. The KCI reps are usually very willing to come out and do this as well. If all else fails there is a phone number for the vac company on the machine which you can call 24/7 with questions. There are also several teaching videos available from KCI which are free upon request. Good Luck!