Wound vac blistering

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Hello all,

I'm an RN but not a lot of knowledge about wound vacs. One of my family members has a wound vac at home which has seemed to be really helping heal this wound. However, over the last couple days there has been blistering that the HH nurse brought to my attention. It's occurring underneath where the HH nurse placed the drape tape.

this morning, I noticed the blisters getting worse, more of them along with rashes and extreme itching under the drape tape. I called the dr on Friday to report this as the HH nurse did not. He ordered PO abx along with cream abx.

When i I saw that the rash/blisters were worse this am. I called the doctor on call and he said remove vac and place wet to dry. I did this about 12 noon today. I did another wet to dry before bed tonight and it's like the wound looks bigger than it did when I first took the vac off.

I am so frustrated and so is my partner. We have been through so much. Two major open heart surgeries in less than a year. My poor baby is miserable.

I can tell you that out HH nurse makes what she calls a "window Payne" dressing which is suppose to protect the peri wound. Well, it doesn't seem to be helping as the blisters and rash are a really bad problem. My baby has tape scarring from the tape that was used in his surgeries so I really think he's allergic to adhesive in general.

I'm in desperate need of some reassurance. I'm about in tears now esp seeing the wound revert and get bigger in a matter of a few hours. It's really not a big wound. It's on the upper back. The wound is Approx 2cml x 2cmw x 1.5cmd.

Plesse respond with your opinion. I'm not asking for medical advice as I have appt with my dr on Monday to assess the wound. I just want to know if this is a common complication. And what you have seen done before in the past. Do they make s special hypoallergenic Drape tape?

Thank you for listening.

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Sounds like a pretty bad adhesive allergy. Stop using the drape, call the MD back, she/he needs to order an alternative dressing protocol. See if your HH RN can do a patch test with the drape material, I don't believe it's necessary but it's always better to be sure. Wet to dry is mostly outdated because of the damage to new tissue. Damp fluffed gauze(non-woven) can work as long as it is changed often and not allowed to dry out completely. Most NPWT manufacturers state that a layer of drape must be placed on peri wound tissue to protect it, you could call their help # and get their advice on the situation.

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The wound vac rep that did our inservice said that pulling the drape taught can cause blistering. We have also used duoderm on periwound skin, rather than drape.

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Great idea since peri wound area is now a wound!

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Sorry to hear your baby is having reactions to wound vac drapes. This happens to some of my patients and I learned to improvise tx that works with the wound vac. The rashes are probably from the sweat and can be from the drapes as well.

So the wound is 2 cm x 2 cm. Where are the rashes and blisters? How far from the wound?

You can try the following. Cover the blisters with duoderm dressing prior to placing the drapes. You can "powder" the rashes with Nystatin powder then cover with Duoderm dressing prior to placing drapes. By "powder" I mean using very little powder and spread them around with your hands/fingers until they disappear. You want to do this because you will cover the area with Duoderm dressing and if theres too much powder, the duoderm will not stick.

Cover periwound skin with small piece of duoderm dressing. Use minimal drapes. If the wound is 2cm x 2cm, cut 4 cm x 4 cm drapes. Trace the wound in center then cut to the size of the wound. Place this drape on the wound. The periwound skin should now be protected with the drape and only the wound opening is exposed. Place your black foam in the wound. Now cover with same 4cm x 4cm drape. Make a quarter size opening in center and stick your tracpad. Now connect to wound vac machine. Make sure your baby does not lay on the tubing and tracpad as this can cause another skin breakdown.

Oh I almost forgot. Prior to doing this, make sure you really clean the surrounding skin and the wound itself.

I've used these techniques on my patients with peri blisters/rashes and they always work for me. Good luck. I hope this will work on your baby's issues.

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Also, please do not use wet-to-dry dressing. This actually harm the good tissue. Use hydrogel soaked gauze instead then cover with silicone foam adhesive dressing. I love these silicone dressing. The adhesive part are silicone based therefore it is very mild to skin.

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Blisters usually happen as a result of tension (ie tension bullae). I have seen that happen more with a vac that is placed in the O.R. during surgery (as the surrounding tissue develops post surgical edema and swelling). However, the itching is a different story. Could be an allergic reaction to the drape or a superimposed candidiasis dermatitis due to the moisture from the blisters combined with use of the occlusive drape. If this were my patient....the wound isn't that deep and I would recommend an alternative dressing and to monitor the periwound condition. Treatment of the periwound with Nystatin and skin barrier film will work if there is fungus.

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One of the best products to use for irritation is Marathon liquid skin protectant. It allows the skin to heal under the drape. Don't pull drape too tight and Zinc is good to heal the irritation. Also try a different drape material, a good one is a silicone drape.

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Sounds like a reaction to the adhesive in the drape. There are some things that could be done to protect the skin but seeing the doctor really is best at this point. Is a wound doctor or practioner following the case?

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