MENDOCINO COAST DISTRICT HOSPITAL
GENERAL PATIENT CARE POLICY AND PROCEDURE STATEMENT
NUMBER: 205.1790
PAGE: 1 OF 4
TITLE: VACUUM ASSISTED CLOSURE (V.A.C.) APPLICATION
PURPOSE:
Patients requiring Vacuum Assisted Closure (V.A.C.) for wound healing will have appropriate evaluation for treatment and correct application of Wound V.A.C. pump and dressing.
POLICY:
Vacuum Assisted Closure (V.A.C.) speeds the closure of open wounds in specific situations, noted below, which results in better patient outcomes.
PROCEDURE:
Physician will determine which patient is appropriate for therapy.
At least one of the following criteria must apply:
1. Non-healing stage III or IV pressure ulcers that are highly exudating or tunneling and are refractory to other treatment modalities.
2. Dehisced incisions prior to being surgically reduced, to better approximate wound edges.
3. Chronic non-healing wounds refractory to other treatment modalities.
4. Certain ulcers related to arterial insufficiency, venous stasis, or diabetes that are chronic, non-healing and refractory to other treatment modalities.
5. Wounds that would otherwise require large reconstructive procedures.
6. Postoperative mesh grafts or flaps.
7. Wounds must be clean, granular with no more than 20% necrotic tissue.
8. Exposed bone, tendon, ligament must be covered with Adaptic or other semi permeable protective dressing prior to application of Wound V.A.C. therapy.
9. Patients with fistulas to other organs must be considered on a case-by case basis for appropriateness of Wound V.A.C. Therapy.
Wound V.A.C. Therapy is contraindicated in the following situations: Malignancy, untreated osteomyelitis, exposed arteries or veins and wounds with eschar or necrotic tissue that covers more than 20% of the wound bed.
Wound V.A.C. Therapy must be maintained for at least 20 hours per day (except for grafts which require 24 hour per day connection) and may not be turned of for any longer than 2 hours at a time.
Equipment List:
· Wound V.A.C. pump
· Wound V.A.C. dressing package
(Granufoam and or Versa foam and transparent adhesive drape)
· Wound V.A.C. canister
· Normal saline
· Sterile cotton applicators
· 4 x 4 gauze
· Scissors
· Skin Prep Barrier wipe or equivalent
Who may change dressing: Dressing can by changed by MD, RN, or LVN who has demonstrated competency.
Procedure Steps:
After physician orders Wound V.A.C., order machine and dressing supplies from Stores. Out patients and Home Health patients must have their machine and supplies ordered directly from KCI (888-275-4534). Certificate of medical necessity, prescription and ordering information must be completed before the machine and supplies are sent. These forms are available from KCI and will be sent when the initial request is called to KCI. For specific information on appropriate dressings see “Dressing Selection” section of this procedure. For specific information on selection of machine settings refer to the “V.A.C. Settings” section of this procedure.
1. Remove old dressing from the wound.
2. Apply Skin Prep barrier wipe or equivalent to intact skin around wound where drape is to be applied.
3. Clean wound with normal saline or Wound Wash Spray. Pat dry.
4. Exposed tendons or bone should be covered with Adaptic or other Vaseline covered wide mesh gauze.
5. Cut wound V.A.C. dressing to fill entire wound cavity. Trim dressing as necessary for proper fit. Place lightly in wound, filling entire wound cavity, eliminating any dead space.
6. After placing dressing in wound, take large adhesive drape and cut to proper width. Apply drape over the dressing and wound site ensuring a seal around body creases and tubing (pinch drape around the tubing).
7. Verify that the drape forms a 3-5cm adhesive contact with intact skin surrounding the wound.
8. Place canister in machine. Connect tubing from the dressing to tubing from canister. Do not lay over bony prominences or creases in skin.
9. For V.A.C. Advance Trac System: Cut 2 cm hole in drape over central area of foam and apply Trac pad after removing adhesive backing. If Trac pad is larger than foam cut a circle of foam large enough to contain the Trac pad and apply over the hole so foam touches foam. Cover with a second drape, cut a 2cm hole and apply Trac pad.
10. Turn on the machine and adjust the V.A.C. therapy settings to ordered settings.
11. Once dressing is in place and therapy activated, the V.A.C. foam should collapse. If the foam does not collapse, check tubing and drape for leaks. Use additional adhesive drape to seal leaks.
12. Change dressing as per physician order. Generally dressing changes will be done every 48 hours initially and may be decreased to three times per week depending on drainage. Infected wounds should have dressing changes every 12 to 24 hours.
13. Canisters are changed when full or weekly, whichever comes first. Canisters may be changed between dressing changes
14. Dispose of canisters and old dressings per bio-hazardous waste disposal policy.
15. Wound V.A.C. therapy may be disconnected for canister change or patient care by pressing Therapy on/off button, clamping the tubing and disconnecting. Tubing ends should be protected to prevent contamination.
Changing the Wound V.A.C. dressing
1. Turn off Wound V.A.C. machine. Clamp tubing on either side of the connection site. If canister is not being changed then protect the open end with sterile gauze.
2. Remove old dressing from the wound. If sponge is well adhered, moisten with saline to prevent damage to wound bed and to minimize pain and bleeding.
3. Repeat steps 2-14 from above.
4. Discontinue therapy when site is ready for graft/flap, wound is completely granulated or at the discretion of the physician.
Note: If dressing adheres to wound bed consider placing Adaptic or other semi permeable, non-adherent, wide mesh dressing between wound bed and sponge.
Note: If pain is experienced during dressing removal despite attempts to moisten with saline, consider introducing lidocaine solution down tubing or inject into sponge. Clamp tubing and remove in 15 -20 minutes.
KCI representatives are available for technical assistance by calling (888) 275-4534.
Documentation
Document in the patient’s medical record.
Monitor every shift for inpatient and every dressing change for Home Health or outpatient:
1. Drainage appearance and amount
2. Appearance of skin around dressing and underneath tubing.
3. Patient tolerance of therapy.
Discharge Planning:
If the patient requires continued use of the wound V.A.C. system
after discharge, notify Case Manager.
Dressing Selection; see fax
V.A.C. Settings: see fax
Recommended Guidelines for wound types: See fax
New: Revised:
Approval Signatures:
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Nurse Manager Date
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Chief Clinical Officer Date
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Medical Chief of Staff Date
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Chief Executive Officer Date
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President, Board of Directors Date