wound vac.

We just got one on one of our LTC pts. It does work rather well when it is in place. This res has a stage III to coccyx to 1 cm from his orifice... the major prob with this is keeping the dressing in place and preventing BM from getting in. Other than that...its healing much faster than previous treatments.

Have worked with VAC's for over 5 years now and have seen some really amazing results. There are several problems inherent to VAC usage though. The first is the physicians use them for every and all patients with wounds that they don't know what to do with. Considering the cost of the dressing this isn't appropriate for everyone. The second is trying to get a seal on some wounds. Sometimes about the only way to keep a seal is to not let the patient move, which causes problems in itself. My major problem is that the nurses on the floors and OR have not been trained in the application of the VAC dressing, let alone the maintenance of the dressings. I work in hyperbarics with another person and we are on call for emergencies, but get called at least once a night (we run 10-20 VAC's in house) expecting us to come in and take care of the dressing. Physicians get really po'd when you explain that a dressing is not an emergency and will be come in the morning to deal with the problem. Another big problem is dealing with KCI (the parent company of VAC machines). They are only profit concious and really don't care about patients in the long run. They have been notified of several problems with the machine that could be fairly easily corrected by appropriate engineering, but would cut into the profit so haven't been fixed to date.

I work on a general surgical floor and recently came into contact with a wound vacuum for the first time on an aka. I read the brochure that the wound nurse left which makes this machine sound like a miracle worker. My questions 1) does this really work THAT well? 2) what are some of the problems that can occur with its use & how do I solve them (I do know the spongy part should be shriveled like a raisin). I work 1900-0700 and we don't have an on call wound nurse at nite! I appreciate any advice!!

I work in home health and have been using Wound Vacs for about 4 years. mackrn brought up great points about the seal and not being able to use on all areas of the body. I would think that one on the coccyx (as michelle mentioned) would be very difficult to maintain a seal on. I have seen wonderful results with these and also poor results. The patient has to be compliant. We had a patient who had a Vac on her foot. She would rarely leave the machine on and it caused some terrible macerations. Kcl needs to get in there and do an inservice for the staff that has no training with them. It is very important to know which sponges to use, assess the current settings, etc. I have had both good and bad experience with KcL. It seems to me that in the past several years (as more Vacs are being used), that they have become a little less accomidating. In the past, if we had questions about the Vac with a particular patient they would go to the home with us and do an assessment. That doesn't happen anymore.

Ann

I was certified to use the wound vac when they first started being used where I work. Maintaining seal on the coccyx can be difficult, but one thing that does help is to use ostomy putty to build up areas that are hard to seal. Duoderm can also help.

When there is a leak in the seal, you can try reinforcing with opsite... it usually works, but not always. Make sure to cut the sponge in the shape of the wound to within 1 to 1 1/2 cm larger than the wound, because when you put it on and the suction goes on, the spong will shrivel. you want to make sure the spong covers the wound, but does not touch new or good skin while the suction is on. Otherwise, you will get skin breakdown to good skin.

We used KCI, but recently switched to a different company (cannot remember who), due to KCI has not dealt well with clients that goes home with a wound vac.

You can see amazing results on most clients, but there are a few that do not heal as well,Especially the noncompliant diabetics.

HI.....I used a wound vac on a private duty case for about 3 months. This did not help us close the patients wound. For one this is very prone to air leaks. Its a cumbersome device, has to be placed just right, and the suction has to sometimes be adjusted until you find the correct one ( Dr. Ord.) Its expensive and so are the supplies. In fact, we feel it actually opened the wound a little wider, and it caused a small amount of bleeding at times. We gave it our best shot, had it down to a science, and still the outcome for us was thumbs down.

hi guys

I work on a general surgical floor and recently came into contact with a wound vacuum for the first time on an aka. I read the brochure that the wound nurse left which makes this machine sound like a miracle worker. My questions 1) does this really work THAT well? 2) what are some of the problems that can occur with its use & how do I solve them (I do know the spongy part should be shriveled like a raisin). I work 1900-0700 and we don't have an on call wound nurse at nite! I appreciate any advice!!

I work on a 70 bed unit Ortho floor and we use them frequently.

I do think they do some amazing work and have some amazing results.

Problems- sure- I agree with PPs about seals and compliance and such. It is also arduous to change the dressing- at least two people and not always under the best circumstance. I do not care for the way the black foam/sponge can end up in the healthy tissue like "crumbs" and then you try and remove it but it becomes impossible because it has grown into that new healthy tissue. (we- the floor nurses do all the dressing changes- Docs and wound care may come look at it once a week?)

Hope that helps.

Holly

We had one, constantly pulling in bm! We switched to the provont wound closure system and had terrific results for our resident!

I do home care and right at this moment I have 4 pts that I see with the vac, (we have 12 going in our office at present) One on the abdomen, and one on a BKA site,(this one started out on the foot, but was the wound was too far gone before the pt finally went to the MD) I have been using the vacs since they first started coming out in the home back in the early-mid 90's. I have seen very good results depending on the patient. If the pt is not compliant, or has other major health problems, you run into issues. I have had a pt who was a diabetic, who just did not want to cooperate. Within 45 min of us putting the vac on, she was turning it off. She would leave the dressing on, put the pump itself was off........ you can only imagine what we would find when we went back 48 hrs later. We did have one man who had a hip replacement that wound up with problems. His incision was the length of his thigh, and about 10cm deep. We placed the vac on him and approx 3 months later it was closed. It took a little longer on him, he was diabetic as well. Seen one lady who the vac closed an abdominal incision in 3 wks.

The seals can sometimes be a problems as others have stated. I have used duoderm under the dressing, lots of skin protectant, ostomy paste, opsite or tegaderm..... and unfortunately in home care, you dont have the luxury of 2 people to place a vac. Its just me, myself and I. So you become creative.

We also dont have a KCI rep come to the home anymore. There are 3 of us who have been dealing with vacs for many yrs so we do pretty much all the vacs. We do have an ET nurse that if we run into a problem, we call her. We ran into problems with the reps not knowing how to place the vac on, or being rude, or just not "having time" to come to a home. So once the vac is ordered and delivered, the nurses take it from there.

Just as a side note, in home care, we have some physicians who have seen the demo, and decide to order the vac. Some pts are appropriate, some are not. Some of the physicians dont know exactly how it works, or even how to place one. I have had to go to the physicians office during the pt appt and place the vac on so the physician could see what it involved and explain it to them. Needless to say, whenever that physician wanted one placed, he called me to ask if it was appropriate. :chuckle

I work 1900-0700 and we don't have an on call wound nurse at nite! I appreciate any advice!!

In the past year my hospital was introduced to the wound vac. At first it was frustrating learning the equipment but it has been worth it. I have seen several of the wounds make miraculous healing times.

We did run into several problems with the KCI products- vacs not holding a charge and alarming-not having great suction which left the wound and all the skin under the seal macerated.

I think one thing to keep in mind is if you feel there is a problem -take off the vac and place the back up dressing until the wound nurse returns in the am. Don't leave it on overnight if you feel the machine is failing.

My hospital went through a time where every wound got a wound vac. Now they are much more discrete and we have a policy to follow prior to placing a wound vac.

hi guys

I work on a general surgical floor and recently came into contact with a wound vacuum for the first time on an aka. I read the brochure that the wound nurse left which makes this machine sound like a miracle worker. My questions 1) does this really work THAT well? 2) what are some of the problems that can occur with its use & how do I solve them (I do know the spongy part should be shriveled like a raisin). I work 1900-0700 and we don't have an on call wound nurse at nite! I appreciate any advice!!

There is a product called Mastisol which is reccomended in the "maintaining a seal" section of KCI's clinical guidelines. Mastisol is used by surgeons in most OR's to secure steri-strips and is basically a "skin glue". It is probably the stickiest stuff in the hospital and is non-water soluble so it holds up in really moiste areas. We started using mastisol at out hospital and it has worked really well for keeping vacs sealed.

There is a product called Mastisol which is reccomended in the "maintaining a seal" section of KCI's clinical guidelines. Mastisol is used by surgeons in most OR's to secure steri-strips and is basically a "skin glue". It is probably the stickiest stuff in the hospital and is non-water soluble so it holds up in really moiste areas. We started using mastisol at out hospital and it has worked really well for keeping vacs sealed.

JR is right. Mastisol is the stickiest stuff I've ever used. We hardly have a problem w/ our Wound Vacs due to Mastisol adhesive. It stands up so well to moisture prone areas. I also like Detachol. It's an adhesive remover made by the same company. It works really well for dressing changes. It takes them right off w/ no skin tears or gunky build-up.