Wound vac question/vent

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I'm a new grad with very little experience with wounds, so I have a situation that confuses me. Am I just experiencing newbie jitters or am I legitimately concerned? The nurse orienting me told me she'd never seen this before either but that couldn't hurt.

We had a patient come in today for wound care on both sides of her foot and her surgeon had placed a wound vac over sutures. She has MRSA in the wound, and possibly in the bone (all following arthrodesis over 6 mos ago), and has had numerous I&D's (including one a couple weeks ago, hence the sutures that are for some reason still there) and at one point the wounds were apparently gaping, deep, tunnelled and had "benefited" from the wound vac before. I've never seen a wound vac on top of sutures...is this something that you have seen before? The wound drains A LOT even through the sutures and when we removed the sponges it just drained like a faucet the whole time. Oh, and she is no longer on IV ABX, just oral bacitracin, so I'm sure the MRSA is still raging under those sutures.

I'm venting, so I'm sorry if my post is confusing. Wound care really fascinates me and this situation seems odd. The patient is followed by bother her ortho surgeon (at our clinic) and an Infectious Disease doc.

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Specializes in Operating Room.

I have seen it placed over sutures in some instances..I work in a OR where we see many traumas..wound vacs happen daily. I'll ask next time, because I'm nosy.:lol2:

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This seems *very* wrong. The wounds will never heal if there is osteomyelitis present, so it seems to me that the first priority should be determining if the bone is infected and if so, addressing that.

I'm also rather surprised that she's only receiving oral meds given the severe infection you described, but since oral bacitracin has been shown to be as effective as oral vancomycin for certain types of infection, it may be appropriate tx at this stage. Do you know how long this patient was treated w/IV ABX before being switched to oral bacitracin only?

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She has been on IV Cubicin twice. If I remember correctly, both rounds were about a month long.

How do you handle situations like this when it just seems like the course of treatment is going nowhere? I know people can carry MRSA forever and may need ABX for their lifetime, but at this rate this poor little lady is going to lose her foot!

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I have seen it placed over sutures in some instances..I work in a OR where we see many traumas..wound vacs happen daily. I'll ask next time, because I'm nosy.:lol2:

I'm nosy, too! That is why I asked about her whole course of treatment. I wanted to know what had been done before. She told me she has tons of pictures of the wound when it was open right after the infection was discovered and that she would bring them next time she comes. I hope I am the nurse (hopefully RN by then!) on that side of the clinic when she does come back.

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Specializes in Med Surg, Ortho.

I've taken wound vac classes to become more knowledgeable on the functions of how and why they're used. This situation, to me, sounds very odd. I work with a lot of wound vacs and have NeVer seen one used on top of sutures. What is the purpose of putting it on top of the sutured wound, I don't understand.

I used to think that wound vacs were for just draining the wounds, but they have another function, along with removing infectious material from the wound, they help draw wound edges together and promote granulation at the cellular level thereby decreasing the time for wound healing.

Where I work, the doc will open up an infected wound, place the wound vac sponge or sponges inside the wound. Sometimes more than one sponge has to be used, so it's very important that whoever puts these vacs in must document accurately how many sponges are used. During my wound vac class, we were told that improper documentation has occured, ie....someone with a tunneling wound had sponges placed inside, this part of teh wound was healing and when the vac was changed the sponge wasn't seen very well and was left inside the wound. Needless to say, they had to go back in there and do it all over again.

Check out this website on wound vacs, it sounds like you may need to educate someone around there and advocate for this patient as much as you can. I also agree with the above post in that scans need to be done (if not already done) to rule out osteo.

http://www.kci1.com/KCI1/vactherapy

Good luck with this situation.

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Specializes in Med Surg, Ortho.

There is a customer support number on the KCI website on the link I listed. Are you all using KCI. Maybe you can call them and ask them about this type of placement on top of sutures. Maybe the doc or wound care nurse that did this hasn't been properly educated on wound vacs, hey it can happen.

At the risk of getting chewed out by the physican maybe you can bring your concerns and ask questions. Where I work, most our doctors welcome our comments and suggestions. Some are a little too proud, but many will take suggestions from the nurses.

This is a time where you need to act as a patient advocate for this poor little woman. inquire with the docs and try to find out what you can, educate yourself as much as possible and don't be too timid to ask the doctors their rational behind placing this vac over a sutured wound. Ask if osteo has been ruled out.

http://www.kci1.com/KCI1/indicationsandcontraindications

This is another link that list contraindications

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"The wound drains A LOT even through the sutures and when we removed the sponges it just drained like a faucet the whole time. "

Oh Boy.

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http://archinte.ama-assn.org/cgi/content/abstract/146/6/1101

having never seen oral bacitracin, and knowing that oral vanco is given for ONLY one thing i had to go looking....it would seem she is receiving NO ABT for her foot wound at all.

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http://archinte.ama-assn.org/cgi/content/abstract/146/6/1101

having never seen oral bacitracin, and knowing that oral vanco is given for ONLY one thing i had to go looking....it would seem she is receiving NO ABT for her foot wound at all.

I'm sorry, I meant Bactrim. The nurse I was orienting with said she had never seen one over sutures either, but it was draining so it must be working....WHAT!? She also said that a KCI rep had done a consult so its ok. UGH! I guess I'll just bring it up as a "learning point" with the doc. He seems pretty open to questions on the right day.

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I have seen a few wound vacs placed over surgical sites with sutures present, but these were muscle flaps or skin grafts. I have even seen the wound vac sponge sutured onto the wound! I have never seen one covering a well approximated wound with sutures. You didn't really describe the current wound in detail, so I'm uncertain exactly what type of wound you're dealing with.

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Specializes in rehab.

Wound vaccs are never placed over sutures.

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