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Wound bed appearance with a wound vac?

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Hello! I'm a home healthcare nurse and I have my first patient with a wound vac - he had a left AKA and the wound badly dehisced. He has a complex history of vascular disease, anemia and diabetes. I am concerned that the wound bed today had a slough or yellow color to it when I changed the wound vac. Is there a typical color it should be? i know that pink/beefy red granulation tissue is the goal, but when should I be expecting to see this color? This is the second time i've changed his wound vac. any input would be appreciated, thanks!!!

Been there,done that, ASN, RN

Has 33 years experience.

Sounds like the wound vac is doing it's job, removing the dead tissue.

However, you have a concern regarding a complicated healing process. Get a message to the surgeon to be on the safe side.

Sounds like the wound vac is doing it's job, removing the dead tissue.

However, you have a concern regarding a complicated healing process. Get a message to the surgeon to be on the safe side.

Thank you!! I appreciate the feedback.

K+MgSO4, BSN

Specializes in Surgical, quality,management. Has 12 years experience.

Talk to your educator about getting the rep from the company to come and do some education. They love to teach new people, plus most of them were nurses at one point.

olive11

Specializes in geriatrics, dementia and like, insurance. Has 22 years experience.

Slough is easy to remove using a q-tip. It's stringy, usually yellow in color, and won't "stick" to the wound. If it doen't come up easily, even after rinsing the wound with sterile saline, then it may be adipose tissue and should be left alone. Go to www.kci1.com and click on the education link. There are videos, photos, and docs with full training on there for each type of VAC.

Most wound VAC companies do NOT have nurses working the field anymore as reps due to cost constraints. Although the reps, territory managers, and such are well trained, they are not nurses. You can find nurses "in-house" when you call the 1-800 number for KCI and when the nurse calls the agency/clinic/office for wound care updates. I recommend talking with them. They are highly trained, have constant updates, and are happy to talk with you about your concerns. Good luck!

Look at the wound: if you assess more than 60% yellow slough then vac is not appropriate tx for wound. Needs more vigorous cleaning before vac will do its job. Alert physician and ask for another tx till they can see. My humble experience... CWOCN since 2012, many vacs since then. Good luck!

CWONgal

Specializes in CWON - Certified Wound and Ostomy Nurse. Has 12 years experience.

Slough isn't always easily debrided with CTA's, ergo the term "adherent slough".

Davidaugustyn

Specializes in WCC. Has 9 years experience.

Ok, to give you some clarified data.

Most times A WOUND VAC IS NOT TO BE USED IN A WOUND WITH SLOUGH.

To word this right, a wound vac is used to pull up granulation tissue and cannot do that with slough in the wound bed. It sounds like you already know this.

On that note, I have had many surgeons request them for BKA, AKA, Abd and other surgical sites to keep the area more approximated, collect the drainage, and keep a sealed contained environment. BUT I have NEVER seen it work well. Usually the VAC is discontinued after a week when the wound declines.

Here are the typical steps I see for a deep wound with adipose that is not surgically approximated:

Surgeon says wound vac it to keep it approximated

works for a time but then the adipose turns to fatty necrosis

Wound vac comes out for a period of further surgical and other forms of debridement (of fatty necrosis)

Scar tissue granulation fills as necrosis debrides. (Don't forget wounds heal from the inside out! Nutrition on board!)

slough is finally gone and the vac goes back on.

To get back to your topic. You have stated "dehisced" and "slough or yellow"

That tells me a few things.

-I have found that leg amputations often have a tendency to "slough up" You may be dealing with a wound that was fully cleaned out but is starting to form more necrosis. Often from further deterioration of an already compromised vascular system.

-If the wound bed was clean, this may also be adherent drainage. If it can be rubbed off (and don't be afraid to get a gauze and scrub unless it bleeds) that I would consider it good and VAC it back up.

-If there is slough in the wound bed, I would not VAC it. This is a matter of opinion, but if there is slough, I have always seen it needing to come out. You can sometimes get away with granulating over tendon or fascia.

I agree with CWONgal. Slough is usually NOT easily removable. In fact, it hardly ever IS.

To clarify, a wound VAC is NOT used for debridement. It is not used and does remove dead tissue.

Any other questions don't hesitate to msg me.

CWONgal

Specializes in CWON - Certified Wound and Ostomy Nurse. Has 12 years experience.

Several other observations. I don't think the silver granufoam is all that and a bag of chips. Personal experience is it seems to trigger an increase in debris.

Also, when you have a compromised limb multiple layers of drape (people either don't have experience or go overboard thinking a little bit more is better) can cause a deterioration in the extremity....have seen volatile feet where TMA's and/or wounds have been debrided and then the layers of drape caused increased moisture beneath and caused more damage requiring even more debridement.