Wound VAC

[TaylorLauren]

I have recently started to learn how to apply a wound vac. I had changed a vac today and the foam was attached to the wound bed. It almost seemed embedded. I soaked and soaked the foam with normal saline and it helped very little. Do any of you have any tricks or advice for foam that becomes this way, so it is much easier for the patient? Also, when you apply the drape, is it okay if it has wrinkles? I was told during a class not to stretch it out to make it smooth because that could cause skin damage. Just wanting all around advice for wound vacs!

[loriangel14, RN]

Yes you need to liberally soak the foam with NS to be able to ease it away. Yes the drape should be as wrinkle free as possible.

[Okami_CCRN, BSN, RN]

I deal with wound vacs all the time, some tricks and tips are to soak the dressing with NS;

-grab a 1L bottle of the stuff and just pour.

-It also helps to pre-medicate the patient with some PRN pain medication just because you're gonna be digging around.

-Try to cut the sponge to the dimensions of their wound and not have the sponge touch their intact skin as it can damage it when the suction is applied

-when applying the drape have a second pair of hands hold the sponge in place.

-you can seal any leaks with more drape or tegaderm

[TaylorLauren]

I soaked it for about 30 minutes and it barely budged! And if there is wrinkles can that damage the skin, or could it just cause issues with the seal?

[TaylorLauren]

Thank you for your feedback! I had a 500mL bottle of saline and almost used it all. Pt did medicate before dressing change. Unfortunately I don't have an extra set of hands when changing vacs so it makes it a little more difficult. :/

[annabanana2]

Sometimes that black foam just... welds itself to the wound bed. Sucks for everyone involved especially if it's really painful. In that case I would probably add a non-adherent contact layer like Mepitel. And of course, do make sure that you've turned off the suction at least 30 minutes prior to the dressing change.

Foam should never be on intact skin, you should be protecting the peri-wound with drape prior to applying the foam. While it does help to have more hands (which I feel is true for most nursing tasks), you can also do things to make it easier to stick down that top layer of drape - for example, you can take a strip of drape (or several) and use it like tape to tape down the foam so it doesn't wiggle around while you're applying the top layer. If you can avoid wrinkles, do so, but don't freak out if you have a few - I find they're largely not a problem unless they cause a leak.

[Tenebrae, BSN, RN]

PRN analgesia

I always put down a layer of cuticerin or something similar with sponge because if a wound is granulating rapidly it has a tendency to granulate up and into the wound.

[TaylorLauren]

So per orders, I changed the dressing again today and put Mepitel down. Hopefully this helps decrease pain for my patient, thank you all so much for your help!