Negative pressure wound therapy (VAC therapy)

 

eg. Vacuum assisted closure brand = VAC

  • controlled negative pressure controls and assists wound healing
  • optimizes blood flow
  • removes exudate
  • maintains moist wound bed
  • hypothesis that it stimulates angiogensis and relieves edema increasing dermal perfusion
  • a dressing is placed into the wound maintains wound bed moisture
  • a suction device is placed over the dressing
  • transparent air tight dressing covers dressing, wound and suction device
  • dressing changes occur q48h

 

 

  • know wound etiology to prevent recurrence and promote healing
  • area requires adequate perfusion for VAC use

 

Who may order VAC use:

  1. Plastic surgeons
  2. Vascular Surgeons
  3. Enterostomal therapy (ET) nurses

 

Each track pad on the VAC drsg is a sensor that measures exudate outflow and prevents exsanguination

Indications

  1. pressure ulcers
  1. diabetic ulcers
  2. traumatic wounds
  3. venous stasis ulcers
  1. abdominal wound dehiscence
  2. preparing wound flap or grafts
  3. securing flaps or grafts post op
  4. acute, traumatic and chronic wounds
  5. cardiothoracic wounds
  6. partial or full thickness burns

 

  • VAC is suitable to high exudate wounds
  • used for treated osteomylitis wounds
  • VACs may used directly over hoffman`s pins

 

Counterindications

  1. if cancer is in situ VAC is contraindicated as the area is highly vascularized and the patient is at risk for exsanguination
  2. unexplored nonenteric fistulas, fistual end must be determined
  3. Infections must be treated prior to VAC use
  4. necrotic tissue with eschar presentation
  5. non-enteric and unexplored fistulas
  6. do not place VAC over exposed blood vessel or organs

 

Care of wound with tendon or visible pulsing vessel:

  • interface area with gelnet, mepatil or vasaline gauze

 

Documentation:

  • chart number and type of dressing components inserted into wound bed so that all may be removed with each dressing change

Protecting intact skin:

  • protect the intact skin on the wound and VAC interface by covering intact area with tegaderm

 

VAC drape (forms the air tight overlay)

  • place side 1 of the drape against the patient, over the black foam packing
  • The track pad is then stuck over the hole the nurse cuts in the drape to allow evacuation of exudate

 

VAC dressing change

  • a half hour prior to drsg change unluerlock VAC tubing and inject saline down tube to pt
  • track pad and tubing are changed at same time
  • wound exudate collection canister is changed weekly
  • if two wounds are in close proximity one VAC may be used
  • intact skin between the 2 wounds must be protected by tegaderm, then foam overlay
  • the track pad hole is placed in the middle of the two wounds
  • zilocaine may be used on wound bed to assist patient wound care tolerance
  • note that excess drape may be used to patch an air leak
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