What's your policy or protocol for vacs?

[homehealth_rn]

Hi all! I want to find out what your agency's policy or protocol is for malfunctioning wound vacs after hours. I'm asking because I was on call last night and had to drive 45 minutes to a patient's home at 2 a.m because his wound vac was leaking. I was always taught that if a patient calls at night, instruct them how to remove the vac and apply a saline dressing until the next morning, then go and reapply the vac. When I tried to explain this to the pt and cg, they both flipped out and said if I didn't come they were going to the hospital. Thoughts?

[paddler]

Our policy is the same. However, I have gone out a 3 am for a wound vac malfunction when I was familiar with the situation and the wound and knew that with the amount of drainage the wound was having that a standard saline dressing would not have sufficed and would have had to be changed every hour or two until a nurse arrived. For comfort of the patient and family I decided to make the visit. But, that was my discretion and choice not policy.

[homehealth_rn]

Thanks paddler. I can understand why you would have made that visit, and I would have done the same thing. I wouldn't have had a problem if the pt or cg's were physically unable to remove the vac and apply a saline dressing due to vision, dexterity, etc, but there were 3 capable adults in the home when I arrived. One of them even followed me into the bedroom to watch because she said she is CNA and likes to watch these types of things. I was furious that all of them refused to do it. On the phone I assured the cg and the pt that I would stay on the phone with them and walk them through the procedure step by step. I spoke with management today because after looking back at previous notes, he has done this several times in the past. Management agreed with me and are addressing the situation.

[caliotter3]

Hope the agency comes to a resolution that is acceptable to all.

[Isabelle49]

Could help if pt/cg are made aware of procedure for malfunctioning vac after hours. That would eliminate the element of surprise when the event occurred.

[indbletrble]

Care of a vac is a routine part of patient/caregiver education at the START. Before we consider accepting a patient for service, we ask if there is a caregiver available AND willing to be taught the vac. If there isn't we do not accept the patient. Part of the basis of home care is the patient takes an active part in their care. Patients and/or family members are taught how to check the dressing for leaks and what to do when one is found. If they are unable to fix the leak, they are instructed to apply a "rescue" dressing (wet to dry normal saline) and notify the agency. A nurse is sent out to reapply the dressing the next day.

[homehealth_rn]

Thank you, indbletrble. This is exactly the point that I made when I went to management. Our supervisor called the patient and caregiver and spoke with them, and they have agreed to apply a wet to dry dressing if this happens again.