wound vac with infected wound?

[athenamcafee]

I'm confused .... I thought one of the benefits of using a wound vac is being able to suck out the infected exudate. At the facility I work I'm being told that a wound vac is never used on infected wound.

When I'm researching on the internet I read where it says the benefits include

"Removes infectious materials and exudates^"

^{Any guidance?}

^Thanks

[Veldtor, BSN, MSN]

I would clarify with your educator and look up the policy.

Our hospital policy states one use is to remove infectious materials and exudate.

There are contraindications, such as eschar in the wound and untreated osteomyelitis.

[athenamcafee]

I was hoping for a discussion of other peoples experiences with using wound vacs, what types of wounds are better suited for wound vacs and what would be contraindicated. Especially if others have seen it used for infected wounds

[jdub6]

I'm not a wound specialist but have seen plenty of vacs used on dirty wounds- off the top of my head I'm thinking of fasciotomy for necrotizing fasciaitis, surgical sites that had been sutured/stapled but the incision was re-opened due to infection and then left open (can't close an infected site) as well as more chronic type pressure or vascular ulcers which sometimes can become infected intermittently- I'm pretty sure that when a vac is already in use with those it's not stopped while they are treated with antibiotics.

In fact now that i think about it infection is one of the major reasons that a wound would be open/ healing by secondary intention and also be at least moderately exudating-common conditions that call for a vac! Did you have any specific reasons that it would be a bad idea?

[tamari07]

Depends on what you classify as "infected". I've had nurses and even MDs see yellow slough and dead tissue in a wound bed and say it was "infected." Usually if a wound has excessive dead tissue and slough it is not ready for wound VAC. The wound needs be fairly clean before initiating a wound VAC and sometimes serial debridements are necessary to clean up a wound prior to starting a wound VAC. You would never initiate NPWT on a wound with large amounts of slough and dead tissue.

In my experience if I have a pt in a wound VAC and there is blantant signs of infection (i.e. erythema, foul odor, purulent exudate, high WBCs), I hold the VAC, place them in a dakins dsg for bacterial management, and consult the MD about starting antibiotics. Our wound physician will go a step further sometimes and order an x-ray to r/o osteo (which osteo is a strict contraindication for NPWT).

Regarding your comment about "sucking out infected exudate": that is not the purpose of NPWT. The negative pressure exerted by the wound VAC increases circulation and blood flow to the wound bed and aides in angiogensis and tissue granulation. Removing exudate is just the "side job" of the VAC, not the primary purpose.

Hope this was helpful.

[athenamcafee]

Very Helpful --- Thanks!!