Using a Vac for undermining

[albg]

Hello Everyone,

I'm hoping for some help in finding some tips of using a KCI portable VAC on wounds that have undermining/tunneling. My husband has a wound care specialist, a KCI nurse-rep and his regular visiting nurse dealing with his care. In two weeks, he's had many low-pressure and blockage alerts due to leaks near the tubes/drape. Tho', we never get a leakage alert, which would help because then I could access the leak detect system. He's already on a second machine, in the hopes that it would work better (only, slightly).

The wounds were caused by a tummy flap opening up at two suture lines and the undermining has created a tunnel leading from a larger wound (11.5 cm x 7.5 cm x 1 .5 cm deep) near his chest to a smaller wound (2.5-3 cm diameter x 4-5 cm deep) which is near the bottom of his abdomen. There is a tunnel that connects the two. It's kind of like a skin bridge between the two, right down his middle. On this "skin bridge" is another hole (2 cm x 1 cm) that resulted from the suture line breaking down. At the big wound, there is more undermining around it - At 1 o'clock: 3-4 cm; 8 o'clock: 8-9 cm and 11 o'clock: 3-4 cm, just under the skin's surface. BTW, he's not Diabetic. The wound looks good. There's no infection or foul smell.

The nurses are all having trouble getting consistent 125 suction in this wound. They're using white foam with a y-connector with one tube going to the large and the small wound, each. We've finally achieved a 48 hour wear time by this morning but there were many alarms and audible leaks from the small wound's tube/drape during that time. I tried to fix it with tagaderm and extra pieces of drape. It would work for a few hours (Phew), then the alarms would start going off again (ARGH!). Normally, I would take it off but we wanted to see if fixing the drape would help.

He's not very active. He stays in bed, so we have no clue as to why he keeps getting leaks. The vac's pressure would go to zero, then climb up to 175 , settle at 100 for a few minutes, then go back to 125. Even when he's laying perfectly still. No one can tell me why.

His nurses have spoken about having two machines to help keep the pressure consistent at 125. Has anyone heard of doing this before? Is this safe? Is there anything *I* can do to help this vac last longer and stay consistent? Is putting on more than one drape necessary? Does foam need to be placed into the undermining? Is there anything I can do with the tubes? Right now, they only cut the foam to be large enough to fit about 1cm all around, underneath the large wound opening. For the small wound, they loosely put a strip of cut foam and curl it (Like a piggy tail) and make sure it touches the strip of foam under the "skin bridge" to make sure everything is holding hands. Then they top it w/ another piece of foam, drape it and add another piece on top. Is this enough? Should the undermining/tunneling have more foam in it?

I understand if you can't answer my question but I thought this would be a good place to try. Thank you for any assistance!

-ALBG

[annaedRN, RN]

Some things in general I've tried when troubleshooting VACs. Is use smaller pieces of drape rather than bigger ones. Place strips of black foam over top of the white foam to help even out the negative pressure. Use skin prep not only on the periwound but also on the edges of the drape itself to help create a better seal. Without being there and actively involved it's hard to make suggestions but those are a few ideas you may have or not already tried or heard of. There is nothing more frustrating than trying to figure out a "leaky" VAC. Good luck to you!

There is various views on whether or not to pack undermining. Often docs are very specific. If the undermining is not severe the concept is that the foam stopping at the wound edge will help encourage the undermined area to close naturally. If the area is bigger it is usually packed ( not tightly) so that an abcess does not form. Depends on MD and the wound itself. If a tunnel is "blind" or cannot be explored properly you are not to pack it.

[BabaLouRN]

I have noted fewer leak alarms by making 100% certain the canister stays upright. One tiny drop on the flap by the leak detector will make the alarm, thinking the canister is wet so it must be full. Nothing you can do but change the canister

[knorahs65]

have you called the KCI 1-800 number? they have tech support that are available 24/7 to assist if it could be a problem with the unit. Also they have a team of Nurses that are available to consult with the field reps if needed. i would think that since white foam is being used the pressure setting should be increased. It can be increased all the way to 200mmhg if needed.

[wound warrier]

Are the nurses cutting the hole in the drape, where the trac pad is, large enough? Need to be about 25 cent size. Have had lots of MD's cut just a slit and then the machine goes crazy. Agree that there are different oppinions on packing areas of undermining, I have had more success with packing undermined areas than not. Please update us on what is going on, as I find this most inteeerresting.

[ramlizRN]

Hello ALBG,

If you are having leaks due to multiple sites try a skin prep or even ostomy paste it will help with leaks significantly. When changing dressing moisten the area well then remove dressing.... I have used skin prep and ostomy paste and it does work..

Good luck and GOD bless you for taking the time to manage the care of your husband..

[ramlizRN]

In addition, leaks are usually at skin fold areas.