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Other: Surgery - Wounds - Wound Vacs
Other: Surgery - Wounds - Wound Vacs [drip and suck wound manager][exploratory laparotomy - wound vac placement]
17
Medical
10/30/2009

Additional Medical Flashcards

 


 

Cards

Term
How often to change wound vacs
Definition

How often to change wound vacs

 

KCI has basic guidelines  for how often a VAC therapy dressing should be changed. Remember the guidelines are not absolute and need to be flexible based on the physicians medical judgement. The VAC Therapy Clinical Guidelines state that:  “Wounds being treated with the V.A.C.® Therapy System should be monitored on a regular basis. In a monitored, non-infected wound, V.A.C.® Dressings should be changed every 48 to 72 hours; but no less than 3 times per week, with frequency adjusted by the clinician as appropriate. Infected wounds must be monitored often and very closely. For these wounds, dressings may need to be changed more often than 48 – 72 hours; the dressing change intervals should be based on a continuing evaluation of wound condition and the patient’s clinical presentation, rather than a fixed schedule” (KCI, 2009).

 

http://vacadvice.com/2009/06/09/how-often-should-the-vac-dressing-be-changed/

 

Term
Wound VAC contraindications
Definition
http://vacadvice.com/category/vac-contraindications/
Term
Wound VAC indications
Definition

Wound VAC indications

 

http://vacadvice.com/category/vac-indications/

Term
Wound vac instructions
Definition

Wound vac instructions

 

http://vacadvice.com/category/vac-instructions/

 

 

Term
Wound vac instructions: Website #2
Definition

 

device that assists in wound closure by applying localized negative pressure to draw the edges of a wound together. V.A.C. accelerates wound healing by promoting the formation of granulation tissue, collagen, fibroblasts, and inflammatory cells in order to completely close or improve the health of a wound in preparation for a skin graft. The use of negative pressure removes fluid from the area surrounding the wound, thus reducing local peripheral edema and improving circulation to the area. In addition, after 3 to 4 days of therapy, bacterial counts in the wound drop.

      In essence the technique is very simple. A piece of foam with an open-cell structure is introduced into the wound and a wound drain with lateral perforations is laid on top of it. The entire area is then covered with a transparent adhesive membrane, which is firmly secured to the healthy skin around the wound margin. When the exposed end of the drain tube is connected to a vacuum source, fluid is drawn from the wound through the foam into a reservoir for subsequent disposal.

      Wound V.A.C. may be used to treat acute and chronic wounds.  The schedule for changing wound V.A.C. dressings vary. An infected wound may need a dressing change every 24 hours, whereas a clean wound can be changed 3 times a week. As the wound heals; the wound base becomes redder and granulation tissue will line the surface of the wound. The wound has a stippled or granulated appearance. Last, the surface area of the wound may increase or decrease depending on wound location and the amount of drainage removed by the wound V.A.C. system. As the wound heals, paler areas in the wound may develop. This indicates an increase in fibrous tissue. 

Assessment

  1. Assess location, appearance, and size of wound to be dressed. Rationale: Provides information regarding status of wound healing, presence of complications, and the proper type of supplies and assistance needed to apply a new transparent dressing.
  2. Assess client’s comfort level using a scale of 0 to 10. Rationale: Data will determine effectiveness of comfort control interventions before, during, and after dressing change.
  3. Assess client’s knowledge of purpose of dressing change. Rationale: determines level of support and explanation required.
  4. Determine the need for client or family member to participate in dressing wound. Rationale: Prepares client or family member if dressing will be changed at home.

 
 
 
 

Planning

Expected outcomes focus on preventing infection, promoting healing, pain control, and client and family education. 

Expected Outcomes (Patient Goals)

  1. Client’s wound shows evidence of healing by smaller size and less drainage, redness, or swelling.
  2. Client reports pain less than previously assessed level (scale of 0 to 10) during and after dressing changes.
  3. Dressing remains intact with airtight seal and prescribed negative pressure.
  4. Client or family demonstrates correct method of dressing changes.

 

Equipment

  •  
    • V.A.C. unit (requires physician order)
    • V.A.C. foam dressing
    • Tubing for connection between V.A.C. unit and V.A.C. dressing
    • Gloves, clean and sterile
    • Scissors (sterile)
    • Skin prep/skin barrier
    • Moist washcloth
    • Plastic trash bag
    • Linen bag

 

Implementation for Wound Vacuum Assisted Closure

Steps

  1. Position client comfortably, and drape to expose only wound site. Instruct client not to touch wound or sterile supplies. Rationale: Maintaining client comfort assists in completing skill smoothly. Draping provides access to wound while minimizing unnecessary exposure.

 

  1. Place disposable waterproof bag within reach of work area with top folded to make a cuff. Rationale: Facilitates safe disposal of soiled dressings.

 

  1. When V.A.C. is in place, begin by pushing therapy on/off button. Rationale: Deactivates therapy and allows for proper drainage of fluid in drainage tubing.
    1. Keeping tube connectors with V.A.C. unit, disconnect tubes from each other to drain fluids into canister.
    2. Before lowering, tighten clamp on canister tube.

 

  1. With dressing tube unclamped, introduce 10 to 30 ml of normal saline, if ordered, into tubing to soak underneath foam. Rationale: Facilitates loosening of foam when tissue adheres to foam.

 

  1. Gently stretch transparent film horizontally, and slowly pull up from the skin. Rationale: Reduces stress on suture line wound edges and reduces irritation and discomfort.
  2. Remove old V.A.C. dressing, observing appearance and drainage on dressing. Use caution to avoid tension on any drains that are present. Discard dressing, and remove gloves. Wash hands. Rationale: Determine dressings needed for replacement. Avoids accidental removal of drains because they may or may not be sutured in place.

 

  1. Apply sterile or clean gloves. Irrigate the wound with normal saline or other solution ordered by the physician. Gently blot to dry with sterile gauze. Rationale: Irrigation removes wound debris.

Nurse Alert: If this is a new surgical wound, sterile technique would be an appropriate measure. Chronic wounds may use clean technique.

 
 
 
 
 

  1. Measure wound as ordered: at baseline, first dressing change, weekly, and discharge from therapy. Remove and discard gloves. Rationale: Objectively documents wound healing process in response to negative pressure wound therapy.

Nurse Alert: Wound cultures may be ordered on a routine basis. However, when drainage looks purulent, there is a change in amount or color, or drainage has a foul odor, wound cultures should be obtained even when they are not ordered for that particular dressing change. An order can be obtained at a later time.

 
 
 
 
 
 
 

  1. Depending on the type of wound, apply sterile gloves or new clean gloves. Rationale: Fresh sterile wounds require sterile gloves. Chronic wounds may require clean technique. However, do not use the same gloves won to remove old dressing because cross contamination may occur.

 

  1. Prepare V.A.C. foam. Rationale: Black polyurethane (PU) foam has larger pores and is most effective in stimulating granulation tissue and wound contraction. White polyvinyl alcohol (PVA) soft foam is denser with smaller pores and is used when the growth of granulation tissue needs to be restricted.
  •  
    1. Select appropriate foam.
    1. Using sterile scissors, cut foam to wound size. Proper size of foam dressing helps maintain negative pressure to entire wound. Dressing must be cut to fit the size and shape of the wound, including tunnels and undermined areas.

 

Nurse Alert: Clients may experience more pain with the black foam because of excessive wound contraction. For this reason they may need to be switched to the PVA soft foam.

 
 
 
 
 

  1. Gently place foam in wound, being sure that the foam is in contact with entire wound base and margins and tunneled and undermined areas. Rationale: Maintains negative pressure to entire wound. Edges of the foam dressing must be in direct contact with the client’s skin.

 

  1. Apply tubing to foam in the wound. Rationale: Connects the negative pressure from the V.A.C. unit to the wound foam.

 

Nurse Alert: For deep wounds regularly reposition tubing to minimize pressure on wound edges. In addition, clients with restricted mobility or sensation must be repositioned frequently so that they do not lie on the tubing and cause further skin damage.

 
 
 
 
 

  1. Apply skin protectant, such as skin prep or Stomahesive wafer, to skin around the wound. Rationale: Protects periwound skin from injury that may result from the occlusive dressing.

 

  1. Apply Wound V.A.C. dressing. Rationale: Ensures that the wound is properly covered and a negative pressure seal can be achieved.
  •  
    1. Cover the V.A.C. foam, 3 to 5 cm of surrounding healthy tissue.
    1. Apply wrinkle-free transparent dressing.
    2. Secure tubing to transparent film; aligning drainage holes to ensure an occlusive seal. Note: Do not apply tension to drape and tubing

 

  1. Secure tubing several centimeters away from the dressing. Rationale: Prevents pull on the primary dressing, which can cause leaks in the negative pressure system.

 

  1. Once wound is completely covered, connect the tubing from the dressing to the tubing from the canister and V.A.C. unit. Rationale: Intermittent or continuous negative pressure can be administered at 50 mm Hg to 200 mm Hg, according to physician order and client comfort. The average is 125 mm Hg.
  •  
    1. Remove canister from sterile packaging, and push into V.A.C. unit until a click is heard. Note: An alarm will sound if the canister is not properly engaged.
    1. Connect the dressing tubing to the canister tubing. Make sure both clamps are open.
    2. Place V.A.C. unit on a level surface, or hang from the foot of the bed. Note: The V.A.C. unit will alarm and deactivate therapy if the unit is tilted beyond 45 degrees.
    3. Press in green-lit power button, and set pressure as ordered.

 
 

  1. Discard old dressing materials, remove gloves, and wash hands. Rationale: reduces transmission of microorganisms.

 

  1. Inspect wound V.A.C. system to verify that negative pressure is achieved. Rationale: Negative pressure is achieved when an airtight seal is achieved.
  •  
    1. Verify that display screen reads: THERAPY ON.
    1. Be sure clamps are open and tubing is patent.
    2. Identify air leaks by listening with stethoscope or by moving hand around edges of wound while applying light pressure.
    3. If a leak is present, use strips of transparent film to patch areas around the edges of the wound.

 

Evaluation

  1. Compare appearance of wound with previous assessment.
  2. Ask client to rate pain using a scale of 0 to 10.
  3. Verify airtight dressing seal and proper negative pressure.
  4. Observe client or caregiver’s ability to perform dressing change.

 

Unexpected Outcomes and Related Interventions

  1. Wound appears inflamed and tender, drainage has increased, and an odor is present.
  2. Client reports increase in pain.
  3. Negative pressure seal has broken.
  4. Client or caregiver is unable to perform dressing change.
  •  
    1. Provide additional teaching and support.
    1. Obtain services of home care agency.

 

Recording and Reporting

  1. Record appearance of wound, color, characteristics of any draingage, presence of wound healing augmentation, such as wound V.A.C., and response to dressing change.
  2. Record date and time of dressing change on new dressing.
  3. Report brisk, bright bleeding, evidence of poor wound healing, evisceration or dehiscence, and possible wound infection to physician.

 

Sample Documentation

1100 client and wife in wound clinic for V.A.C. dressing change. Wound on lower abdomen is pink, moist, and without edema in periwound region. Size decreased to 2 x 2.2 cm. Client states that there is less pain in wound area. Comfort achieved by 600 mg Motrin. Dressing is still changed every 48 hours. Wife correctly perfomed dressing change and activated wound V.A.C. to 125 mm Hg; continue with dressing changes every 48 hours 
 
 

.

Special Considerations

Pediatric Considerations

  1. This wound application is not appropriate for fragile neonatal skin
  2. Parents need to actively participate in wound V.A.C. treatment

 

Geriatric Considerations

  1. Use skin care practices to protect periwound tissue.
  2. Transparent film may be irritation to fragile skin. Skin protectant is one method to reduce the risk of tissue injury.
  3. Visual impairment may prevent self-care and require home care services.

 

Home Care Considerations

  1. When wound V.A.C. is used in the home, the client and caregiver may benefit from initial visits with home care agency to monitor initial treatment.s
  2. Provide information to family and caregiver regarding proper disposal of contaminated product.

 

http://74.125.155.132/search?q=cache:4wHpBl7B0oUJ:instructor.mstc.edu/instructor/csebasti/543-102%2520Nursing%2520Skills/Skills/Wound%2520Care/Study%2520Guide%25201%2520WOUND%2520VACUUM%2520ASSISTED%2520CLOSURE.doc+how+often+should+i+change+the+wound+vac&cd=1&hl=en&ct=clnk&gl=us

 

 

Term
Wound vac instrutions #3
Definition
http://www.worldwidewounds.com/2001/may/Thomas/Vacuum-Assisted-Closure.html#ref28
Term

43M s/p with morbid obesity, s/p right hemicolectomy and incisional hernia repair on 9/14
9/23 readmitted for stool leaking from wound (colonic fistula), started on drip and suck wound manager, NPO, PCA
04124078 9/13
- Drip and suck wound manager is a bunch of tegaderm, and it provides continued irrigation.
http://www.eakin.co.uk/Uploads/Docs/Eakin_VAC_Case_Studypdf.pdf

Definition
Term
Website for Medical Students
Definition
Term
Putting on a wound vac
Definition

Putting on a wound vac

 

EQUIPMENT

- you need to have your equipment

- you need a wound vac kit (in a plastic bag, contains the foam, the adhesive tape, and the suction piece)

- you need the vaccuum machine

- the suction tubing and piece, which comes in the big plastic bag

- need the case that connects with the vacuum that eventually collects all of the fluids and is connected to a plastic tubing

- you need a number 11 blade

- you need scissors

- sterile drapes would be helpful to have

 

- Cavilon "no Sting Barrier Film" kits

 

 

 

REMOVE THE OLD WOUND VAC

- turn off the vacuum

- take off the container, on the side of the vaccuum machine with the fluid inside it. tie the tube connect to it at it's end. throw that whole think in the biohazard bag.

 

Remove the old wound vac from the patient

- get adhesive swabs to wet the tape and separate the tape from the skin

- remove the tape from one side

- When you are removing the tape, pull the tape parallel to the skin, it makes coming off easier
- Remove the foam from the wound surface, the part that sticks to the tissue should be rubbed off gently, sometimes you need some normal saline to pull it off

 

PUT THE NEW FLUID CONTAINER IN THE VACCUM MACHINE

 

OPEN THE BAG WITH THE TAPE AND FOAM AND SET THINGS UP

- there are several? sizes of the foams. make sure you get a size large enough for your wound.

- in pediatric patients, use an 11 blade to cut the foam in half longitudinally. A second person can help hold it while you cut the piece length wise in two mirrorred pieces.

- use  the Cavilon "No Sting Barrier Film" q-tips to apply the no barrier stuff around the skin edges so that when the tape comes off later, it doesn't burn!

- place the wound vac over the wound and cut it so that it borders but is not extending past the wound edge.

- you might need to cut small pieces from your second pice to fill in nooks and cranies of the curves made by the wound

- get the large tape and cut it in half. you want to layer it in pieces, rather than stick one large wound vac tape over the wound.

- this part takes two people; one person holds the foam in place while the other person takes half of the tape and places it over the top of the wound. cut extra areas that go over central lines or EKG strips or etc.

- do this in staggered fashion until your whole wound is covered

- if you have a deep crevice that you cannot close, you can use the stuff of stomas and mold that stuff to fit into your crevice and create a seal

- Once you feel you have a good enough seal, you can then cut a little nick in the middle of the wound vac tape

- this area is covered by the opening of the round stuff. The opening of the round stuff should be the same size as the hole you made int he wound vac.

- put the round stuff over the whole.

- turn on the vacuum.

- It should seal up good.

- If it is not well sealed, you will hear a hissing sound and will have to adjust.

 

learned this from josh and laura on 10/4/2010

learned from Dr. J from working with patient on MIS

Term
Changing a wound vac: My experience with Dr. J with adult patients
- Equipment you'll need: List it here:
a.
b.
- Tell the nurse that you will need to give 0.4-0.5mg dilaudid; the nurse should stick around to help if you are doing a big wound vac change and to also give the patient more pain medication
- Walk into the room
- check to make sure that you have the big wound vac bag (with the tegaderm like tape and connection tubing); the canister for the wound vac, scissors, drapes, N-terface, Actigall, sterile suction tip and suction tubing and canister for suctioning, chucks, sterile gloves
- After you check your equipment, make the patient lay flat in bed by flattening the head of the bed
- now if the patient is turned on her side, go ahead and pull the chuck from underneath them so that they can be turned so that they lay flat on their back and not on their side
- Take the chucks and put them on the patient's sides
- take the restraints and tie them so that the patient's arm cannot reach the
Definition
Term

Equipment for wound vac change
Order from storage
1. Acticoat (largest size 16x16)
2. N-terface
3. VAC GranuFoam Dressing X-Large

From omnicell in Room #1
- sterile gloves  (or regular gloves)
- 0.9% NS irrigation
- sterile tubing (Medi-Vac nonconductive suction tube with Maxi-Grip connectors 1.8inch)
- sterile suction tip

 

From omnicell in Room #2 (nutrition)
- sterile scissors
- Sterile towels (or not)

 

Unknown room

- Wound vac canister
- the part that connects the wound vac to the canniser, that has a round thing at the end that you stick over the hole you make on the wound vac (you want an extra one)
- sterile drapes (or not)
- Extra medium size and large Tegaderm
- Extra 4X4 gauze

 

Definition
Term
What do you do if you have a gastric fiscula draining into your abdominal wound?
- Put a tube through it using IR. We first put in a small tube, and then we put in a PEG tube.
- You also put the drain connect thing over the wound vac site over the drainage site.
Definition
Term

DO NOT EVER place a wound vac over an exposed artery, vein, nerve, etc. The structures will erode! and you will get hemorrhage!! DO NOT DO IT!
From M&M of patient who hemorrhaged after wound vac was placed over exposed artery, etc after a machine accident. 2/11

 

for contraindications of wound vacs

http://www.brianthemountainram.com/2010/10/04/how-to-manage-wound-vacs/

Definition
Term
(We close the fascia, and then we placed a wound vac. The abdominal wound was about 1ft in length and 1 inch wide.
- Cut a size estimate of the wound from the wound vac sponge and place that over the wound
- Remove the bottom part of the large clear tape
- Place the large clear tape over the sponge on the abdomen taking care that the sponge is situated within the wound and not on the skin
- Cut a line for any drains before you completely lay down the tape
- Now remove the TAPE AT THE EDGE
- Now remove the TAPE AT THE TOP
- Now get a scissor to cut a small whole in the wound vac
- Place the top part over this
- Remove the BOTTOM TAPE from the edge
- Remove the TOP TAPE
- While in the operating room, turn on the wound vac to make sure it works and leave it on

7/12/11
Definition
Term
If you're going to leave the abdomen open, use Abthera.

7/14/11
Definition
Term
When the wound nurses change the wound vac, they will page you so that you can see it. It is a good idea to take a picture too, and even upload it on the patient's chart.

7/14/11
Definition
Term

Troubleshooting: Wound vac has lost suction

- You get a call that the wound vac or ABThera is not suctioning. What do you do?
1. Go to the patient's bedside
2. Ask the nurse to connect the tubing to wall suction
3. Get this equipment
- Gauze
- Chlorhexadine
- BENZOIN!
- Tegaderm
- The wound vac special Tegaderm

4. Lay the patient FLAT on the bed
5. Look at the wound vac. Is it sucking fluid from the area into the tubing? that means that the suction isn't holding.
6. Find an area that you feel is suspect and press hard on it (press hard on a large area if you have to) and see if that brings the suction back.

7. If this doesn't work, just remove the whole wound vac tapes
8. Get a wash cloth, put soap on it and clean the skin REALLY, REALLY well, to get off all the drainage and goo
9. Dry the skin really well
10. place lots of benzoin around the edges really well, bit area
11. fan the area to dry the skin
12. Have someone stretch out the skin as you place the wound vac tegaderm tape on to the skin

13.The wound vac tape.
a) Place it on
b) Remove the bottom part on the sides (#1)
c) Remove the top part - 1 big swoop (#2)
d) Remove the blue sides

14. Let's say you have two different areas that need to be wound vacced. You do not necessarily need two different drains. You can use 1 drain. But the trick is to make it so that they share a foam piece.

15. Now cut out a 1cm hole from the middle of the tegader

16. Place the suction on it

17. Put it to wall suction

18. Then clamp it and then connect it right away to the vacuum

19. Dan showed me how to do this. I learned a lot .

Definition