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!

Hi smith. It sounds to me like the nurse who did the initial assessment did not document correctly. If the wound is indeed pressure related, it should have been staged, measured and described at the time of assessment. It is not really okay to just document, "wound" well is it a stab wound? A laceration? A surgical wound? Etc. Sounds like the next nurse determined it was pressure related. Let me give you an easy run down of how to stage pressure ulcers. Stage 1- A non blanching red area, that does not go away. Usually over a bony prominence. Stage 2- The 3 P's! Pink, Partial, Painful! Stage 2 wounds are partial thickness and often resemble a very shallow ulcer with a reddish-pink wound bed. NO SLOUGH. If there is slough present, it must be staged as a Stage 3. Stage 3- Full thickness wound. This is why there is slough in the wound bed. These wounds may have undermining and tunneling but there is NO muscle, tendon or bone exposed. If there is, it should be documented as a Stage 4. Stage4- Full thickness tissue loss with exposes bone, muscle or tendon. It usually will have slough or eschar as well. These wounds can tunnel and undermine as well. Unstageable- These wounds are completely covered with eschar or slough and the wound bed is not visible. For this reason, you cannot stage them because you don't know what is under all that gunk! I hope this helps!