Today, I made rounds with Angela Box, the hospitals certified wound and ostomy nurse. While she also takes care of wounds and ostomies, she also makes rounds for the anthesiologists on their PCA pumps and starts PICC lines. The most interesting thing I saw was a man who had a large abdominal wound and was being treated with a wound vac. He had acquired this wound as a result of and abscess caused by the mesh that was used to repair his abdominal hernia. Initially, when she saw him in the morning, she had decided to try and dress the wound using a dressing called Oasis, which she said was made from pig intestine. She placed a 1” x 3” strip of this dressing over a small hole in the wound, applied Xeroform gauze and then taped it securely. She told the patient that this dressing should last until Monday. But about an hour later we had to go back and put the patient back on the wound vac. It was a simple procedure. She cut the sterile black foam to size, placed it on the wound and attached the tubing from the wound vac to the foam. Used a large opsite type dressing and covered the wound and the foam. Then she turned on the machine and set it to the appropriate amount of suction for this patient. I asked the patient if it was uncomfortable to use the wound vac and he stated it was not.
We also talked about how she became the wound nurse for the hospital. She initially started out as the IV nurse? Somehow she started assessing wounds. She decided to take some classes so that she could gain the appropriate credentials. She is now a certified wound and ostomy nurse.
It was an interesting day. I went to dialysis, ICU, recovery, and the other two floors of the hospital. I think this might be another area to consider when I get out of school.
Wound Vac Treatment
Vacuum assisted closure (VAC) therapy is designed to promote the formation of granulation tissue for faster healing in the wound beds of patients with acute and chronic wounds. It draws wounds closed by providing controlled negative pressure to the area. It removes drainage and provides a closed, moist healing environment. Some additional benefits of this procedure are:
· Reduces localized interstitial edema
· Increased blood flow to area
· Promotes new granulation tissue formation
· Reduces bacteria in the wound
Indications for usage: chronic open wounds, diabetic ulcers, pressure ulcers, skin flaps and grafts, dehisced wounds, and partial thickness burns. It is contraindicated in patients with malignancies in the wound, untreated osteomyelitis, unexplored fistula, and necrotic tissue with eschar present. One should not place a VAC dressing over exposed blood vessels or organs.
To apply a wound vac dressing, one should follow the following procedure:
· Appropriate physician order
· VAC Unit and canister
· Vac foam sponges and suction tubing
· 2 Large Opsite type dressing
· Ordered wound cleaner
· Gauze sponges
· Clean wound as ordered by MD
· Cut the foam to fit the wound bed and place in the wound bed
· Apply opsite type dressing
· Cut a small hole in the clear dressing and attach suction tubing
· Place second clear dressing over entire wound bed
· Connect suction tubing to the canister tubing
· Adjust the setting as ordered by MD.
Dressings are usually changed every 48 hours and clean technique is usually used.
Some before and after photos of patients receiving wound vac therapy courtesy of: http://www.uth.tmc.edu/anes/wound/vac.htm