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Wound Vac

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Autor:  jon1269  04 April 2010
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Clinical Journal

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
· Gloves
· Scissors
· 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.

Source: http://www.kci1.com/index.asp



Some before and after photos of patients receiving wound vac therapy courtesy of: http://www.uth.tmc.edu/anes/wound/vac.htm



S.M.: 43 y.o. male with IDDM s/p 5th digit amputation and resection of 5th MT head; dramatic increase in granulation tissue after approximately 3.5 weeks of Vac therapy.

Before and after photos of patients undergoing VAC therapy:


2/12/2003 2/19/2003 6/04/2003

8/20/2003 09/24/2003
Same patient struggling at the same time with this foot wound, VAC placed on the foot, note the small tract which required packing with sponge as the wound healed.




























Nursing Diagnosis Short Term Goals Nursing Interventions Scientific Explanation of Nursing Interventions
Potential for Infection related to impaired oral mucosa.Supporting Data: Teeth poor condition with dental caries.Missing teethDry mouthReports bad taste in mouthHalitosisWhite patches on tongue. Improvement in condition of oral mucosa.Goal Criteria: The patient will reduce potential for infection by maintaining a healthy oral cavity as evidenced by:· absence of inflammation and discomfort· Pink, moist, intact mucosa. The Student nurse will:1. Instruct and assist client to perform oral hygiene as often as needed (after meals, bedtime) using a soft bristle toothbrush and floss teeth gently.2. Avoid use of mouth washes containing alcohol and oral care products containing lemon and glycerin.3. Encourage patient to rinse mouth frequently with water and lubricate lips.4. Encourage fluid intake.5. Encourage patient to suck on hard candy.6. Encourage client to maintain an adequate nutritional intake.7. Obtain dental consult for dental caries. 1. Good oral hygiene helps maintain health of the oral mucous membranes by removing food particles and debris that harbor the growth of pathogenic organisms that can cause inflammation and infection. Brushing teeth also stimulates circulation to the gums. Using appropriate oral hygiene devices help to effectively remove food particles without causing trauma to oral mucous membrane.2. These products have a drying effect on oral mucous membranes. Excessive use of lemon glycerin products increases acidity in the mouth which can cause further irritation in the mouth.3. Frequent rising of mouth with water helps alleviate dryness which reduces cracking and breakdown of oral mucosa. Rinsing also helps prevent inflammation and infection in the mouth by removing food particles and debris that can promote the growth of bacteria. Lubricating lips helps alleviate dryness which reduces cracking and breakdown of lips.4. Adequate hydration helps keep the oral mucosa moist which reduces the risk of cracking and breakdown.5. Sucking on hard candy promotes salivation which helps alleviate dryness of the oral mucosa and the risk of cracking and breakdown. Saliva also helps maintain oral mucosal health by washing away debris.6. Adequate nutrition is needed to maintain the high cellular turnover of the oral mucous membrane. Good nutrition also promotes optimal function of the immune system which helps avoid infection.7. Dental caries can progress to abscess and gum infections and further cause pain and discomfort for the patient.


























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