Vac Dressings

[northerner60]

Have a resident in a nursing home setting that has a vac dressing....difference of opinion on whether clean technique or sterile technique should be utilized when changing the dressing. Share your expertise so that we can 'possibly' come to a consensus. Thanks a bunch.

(P.S. you may have already had discussions on this topic? new to allnurses...looks like a great site!)

[Gr8Dane]

Sterile, or supposed to be at least. Since your inserting foam into the actual wound, you don't want to introduce anything which may cause a new infection. Generally in my past experience in assisting with wound vac dsg changes, we do a sterile irrigation, dry out, using sterile gloves measure the wound, check for undermining and then estimate what size to cut the foam into to fit snugly into the wound.

That is just what I have observed on every change we have done. But at the same time sterility is broken often. I have only done one on my own and I tried to use sterile technique but it ended up becoming a clean change due to location and pt. size (bariatric).

Others with more experience may say otherwise. I'm still new to nursing.

[jessiern, BSN, RN]

My husband has a wound care certification, and does wound vac dressing often. He uses sterile technique, but has said it was not needed in most cases because most wounds that require the dressing are chronic and already have contaimanation in the wound be. We also looked on the website for the company that makes wound vacs:

Is the V.A.C.® Dressing change a clean technique or sterile technique?

V.A.C.® disposables (canister, dressing and tubing) are sterile when received by the facility. Dressing applications regarding clean or sterile technique are completely physician/clinician preferences. A clinician has the option of applying the dressings in the OR utilizing a sterile/aseptic technique, if needed. He or she also has the option of using clean technique for placement such as in the home, or for pathologies that do not require sterile technique. As with all dressings that are packaged sterile, the options for use lie with the protocols and institutional policies regarding wound care.

[suzanne4, RN]

Wound Vac dressing changes should always be sterile, you do not want to introduce anything into the wound. This is what is done in the hospital setting. And Wound Vacs are not used just on chronic wounds, but they can be acute as well.

In the home, things are done very differently.

[TazziRN, RN]

Clean. I do home care, nothing is considered sterile in the home, not even cath changes/insertions.

[BlueRidgeHomeRN]

clean. i do home care, nothing is considered sterile in the home, not even cath changes/insertions.

not to mention--is everyone else using sterile disposable scissors? cause if not, so much for sterile once you start shaping the foam!?!?

[seanpdent, ADN, BSN, MSN, APRN, NP]

not to mention--is everyone else using sterile disposable scissors? cause if not, so much for sterile once you start shaping the foam!?!?

suzanne hit the nail on the head. it all depends.

of course it's ideal to have it sterile, but each scenario and setting will dictate what is the ideal.

i work on a surgical/ trauma icu, we use vac's a lot for dehissed wounds, acute injuries, and with chronic wounds.

some patients have order to have the vac changed by the nurse at bedside, while others go to the or for a formal vac change.

:paw:

[Boston-RN, RN]

I would go with whatever is ordered and/or policy procedure. I learned from a very experienced wound care nurse that there is no need to do sterile tech. As she explained to me if you use good clean technique then you are not introducing anything into the wound that is not already there.

That being said, always follow orders and P&P.

[northerner60]

Thanks for the feedback. At this point in time we will rely on P & P and Dr.'s Orders. Really appeciated the feedback....it has been helpful.