wound vac.

Specialties Wound

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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.

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.

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Specializes in Community Health Nurse.
I work on a 70 bed unit Ortho floor and we use them frequently..................................................................................

Holly

70 BED UNIT???? :eek: :eek: :eek: I didn't even know units existed with that many beds! How's the staffing ratios? :redlight:

The wound vacs are new to me. I floated to a neuro unit one time where a wound vac was in use on a patient's leg. I'd never seen one before that time, and this was just a couple of years ago. Seemed interesting. :)

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Hi! I'm a wound care nurse at a hospital . The Dr. will usually ask our recommendations whether the pt would benefit from a vac. most of the time they do and yes they actually do help the healing process quicker. At our facility we change the vac m-w-f. The sponge does have to have a good seal to work, if it does leak we will reinforce the seal with a clear transparent dressing or a tegaderm.

BethAnn-

Hello. I work in a small hospital that occassionally has a wound vac on the med/surg floor. I am not a wound care nurse, but have had to change a wound vac dressing. The one I dealt with was straight forward. Lately I have seen some improvising that seems counter-intuitive. By the way, I have never seen the brochure that the company provides. The nurses on the floor most experienced with the wound vac are the ones who have worked in home health before. Wondering what you think about the following:

1. Using some black and some white sponge in the same wound with one vac.

2. Packing black sponge under skin in a tunneled area. Using a seperate piece over it.

3. Not just cutting the sponge in the shape of the wound, but thinning the sponge. This is where many flakey bits come from.

4. Using adaptik under the black sponge where debridement is a goal.

5. Having the patient shower prior to dressing change to loosen adhesive and reduce pain.

Curious to have input from you or anyone else who has some good experience. As a new nurse, I know that many nurses have different dressing preferences or methods, but it seems with the wound vac that the use is based on proven test results using specific guidelines. Seems sort of expensive to ad lib, money and cost of time to patient etc.

Thanks

waves

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1. Using some black and some white sponge in the same wound with one vac.

2. Packing black sponge under skin in a tunneled area. Using a seperate piece over it.

3. Not just cutting the sponge in the shape of the wound, but thinning the sponge. This is where many flakey bits come from.

4. Using adaptik under the black sponge where debridement is a goal.

5. Having the patient shower prior to dressing change to loosen adhesive and reduce pain.

When you talk about the 'white foam', are you talking about Versafoam? I use that exclusively for tunneling as it will not pull apart like Granufoam will. We had a situation once where some Granufoam was left behind in some tunneling and new tissue began to grow over it. It had to be debrided out or would eventually abcess. We don't "pack" anything, but make sure that there is a piece of Granufoam over the top and touching so that it will remove excess drainage.

We thin our sponges when indicated. It's not the point of it to be 2 inches above the wound. 99% of our foam is cut in half. Make sure you cut away from the patient and "brush" the foam before applying it to their wound. You should eliminate any "crumbs" that way. All of our cutting is done over the clean table unless we need to trim, which is still done on another table specifically for this purpose.

If a wound needs to be debrided, it's contraindicated in WoundVac. It needs to be debrided before it is applied or it does no good. I've never heard of using anything to debride while the system is running as a) it will get sucked out if it is a cream or b) it will adhere to the Versafoam and cause a barrier.

We don't let any of our patients get the area wet with plain/soapy water. We use only sterile water for each of our procedures and if it's in a pt. that can shower, it must be bagged or covered or else they have a bed bath. You'd have to ask someone else on that one, although we do not let them "loosen it in the shower". Too many places for bugs to get into it. We use No Sting Skin Prep (i think by McKesson) for sealing the tegaderm and also window pane each wound to prevent drainage from seeping underneath. It's been a godsend to do it that way, although KCI doesn't show that on their training video. A knowledgable rep we had tipped me in on that one. :) I also use an adhesive dissolver for removal (also made by McKesson but can't remember the name).

Regardless of age, location, depth, etc....WoundVac isn't going to work unless the patient is nutritionally sound. We feed our massive WV's almost like a burn patient, as they need massive amounts of protein for healing. Right now, I'm battling with one that has an albumin of 2.0. Not really conducive with wound healing.

I have a love/hate relationship with WoundVacs. I've seen them work more often than not, but it's soooo time consuming battling those that aren't.

HTH.

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Thanks so much for your very complete answer.

What do you mean by window pane the wound?

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Woops, sorry!

I cut thin strips (1/2-1") of the Tegaderm sheets and go around the wounds (right on the edge) before I put the foam in and seal it. It gives the Tegaderm something to stick to, and if there was wound drainage before I sealed it, it will stop it from going under and breaking down the good tissue.

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Specializes in Emergency.

Have you ever used the wound vac on a post-op lumpectomy wound that doesn't heal? I am unfamiliar with these devices; we don't use them in ER.

What was the fastest healing time anyone saw?:cool:

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In my LTC facility we have used the vac on and off for years. Like others have said it works really well for most but not all sores/ulcers. Each time we get a new VAC order, we have KCI come out and inservice the nurses on application and usage of the device. I have had the misfortune to actually have the VAC to wounds that I had. The first time was for post

op hysterectomy surgical site that seperated. I had the VAC applied on a Friday and by Sunday I was in tears because I felt like a dog on a leash. That wound vac was heavy to carry around with you, certainly above my weight restriction. It didn't hurt much though. In December I had to have it again post op from a bowel resection d/t perforated bowel and removal of recently placed mesh from a laproscopic hernia repair. This time when they changed the dressings it hurt like h***. After about 3 dressing changes I refused to let them apply it again. Went with w/d dressings.

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When you talk about the 'white foam', are you talking about Versafoam? I use that exclusively for tunneling as it will not pull apart like Granufoam will. We had a situation once where some Granufoam was left behind in some tunneling and new tissue began to grow over it. It had to be debrided out or would eventually abcess. We don't "pack" anything, but make sure that there is a piece of Granufoam over the top and touching so that it will remove excess drainage.

We thin our sponges when indicated. It's not the point of it to be 2 inches above the wound. 99% of our foam is cut in half. Make sure you cut away from the patient and "brush" the foam before applying it to their wound. You should eliminate any "crumbs" that way. All of our cutting is done over the clean table unless we need to trim, which is still done on another table specifically for this purpose.

If a wound needs to be debrided, it's contraindicated in WoundVac. It needs to be debrided before it is applied or it does no good. I've never heard of using anything to debride while the system is running as a) it will get sucked out if it is a cream or b) it will adhere to the Versafoam and cause a barrier.

We don't let any of our patients get the area wet with plain/soapy water. We use only sterile water for each of our procedures and if it's in a pt. that can shower, it must be bagged or covered or else they have a bed bath. You'd have to ask someone else on that one, although we do not let them "loosen it in the shower". Too many places for bugs to get into it. We use No Sting Skin Prep (i think by McKesson) for sealing the tegaderm and also window pane each wound to prevent drainage from seeping underneath. It's been a godsend to do it that way, although KCI doesn't show that on their training video. A knowledgable rep we had tipped me in on that one. :) I also use an adhesive dissolver for removal (also made by McKesson but can't remember the name).

Regardless of age, location, depth, etc....WoundVac isn't going to work unless the patient is nutritionally sound. We feed our massive WV's almost like a burn patient, as they need massive amounts of protein for healing. Right now, I'm battling with one that has an albumin of 2.0. Not really conducive with wound healing.

I have a love/hate relationship with WoundVacs. I've seen them work more often than not, but it's soooo time consuming battling those that aren't.

HTH.

In Homecare, I have worked with several vacs. I agree with all the above. FYI- also have noted problems with y-connectors not sealing tight causing an "air leak" alarm. Took forever to figure that one out. :)

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I suggest that you talk to your head nurse and talk to her about how you feel. Nobody should be asked to work with a wound vac without some instruction. It isn't fair to you or the patient!

The head nurse can contact your WOCN nurse and request that she spend some time with you (or your unit) for instruction. The KCI reps are usually very willing to come out and do this as well.

If all else fails there is a phone number for the vac company on the machine which you can call 24/7 with questions. There are also several teaching videos available from KCI which are free upon request.

Good Luck!

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