Wound vac question/vent

[Nursetastic]

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.

[kcicc]

So that sounds like a terrible wound of course and likely a difficult dressing change no matter what is being used. If this pt is in acute care, often times I have seen wounds like these NOT vac'd as the perception is that it would be impossible to get a seal, too time consuming etc. However, a couple of tips and these "impossible"wounds can be VAC'd too. Colostomy done, so we don't have to be too concerned w/ that. If sphincter is still in place, that should be covered with white foam or adaptic as should any exposed vessels, organs etc. The XL dsg is great for irregular shaped wounds as it is seamed/serratted and more mold able. So the secret here in addition to plenty of skin prep and 4X4s is an O2 extension tube! Connect the tube to the O2 and crank it to 10-15L! You can now use this to spot dry the skin as you are applying the drape. This simple technique has been used on some pretty complex nec fash wounds that were very moist/wet. Take your time, plan ahead, apply the drape in strips and it should work. If not for this pt, maybe the next. Believe me, you'll be everyone's hero!

[NRSKarenRN, BSN, RN]

See KCI Prevena: the first powered negative pressure wound therapy product, is designed for management of closed surgical incisions.

New thread in Home Health forum: Dr's using negative pressure devices (vac's) on closed surgical incision

[jadelpn, LPN, EMT-B]

Seems like there's a couple of things going on. IF one has a closed surgical wound, and no infection present, then I could see how a wound vac could promote healing over sutures. Brings the edges together, that type of thing. Great idea.

What you seem to be describing, OP, is an infected wound, that I would think the wound vac needs to be used in an alternate way. The sponge actually has to be fitted INTO the wound for it to do anything. Even more so, by encouraging the closing of the surgical site, ya'll will be back at square one when the wound closes, and the infection is still present and is damaging to the underlayers of the skin. I would worry sepsis in that instance.

Osteo in my experience (and this is not medical advice per TOS, just some thoughts) is mostly controlled/cured with Vancomycin. And most usually IV. Sometimes with an alternate antibiotic as well, such as rocephin, again, IV. Even though the patient is on oral antibiotics, it couldn't hurt to get another culture, and see at this point what it is growing. And I would advocate that because of the immense amount of drainage, that the sutures are removed, that you use the vac inside of the wound, and an alternate course of IV antibiotic treatment. With a wound vac, the wound heals "up"...in other words, it heals from he base of the wound to the outside of the wound. Therefore, to be able to get the sponge down into the wound would be helpful to this patient.

Wound vacs are highly billed money makers for a facility. So that now they are being used to promote a healthy surgical site to heal better doesn't surprise me. What does surprise me is that the MD is not aggressively treating this patient's infection, as well as her wound in such a way that it will actually heal, once the infection is addressed.

What you could also do, is advocate for the patient to be seen at a wound care center. When there are complex wounds with infection, wound care MD's and nurses are amazing at what they do. And they can point you all to a treatment plan that will be to the patient's function and benefit.

Let us know how it goes!