Follow Wound Blog on Twitter

Follow Wound Blog on TwitterI have been working lately on improving how wound blog communicates with the over 13000 searchers who have found this site in the last year. I have connected with twitter to provide RSS feeds letting you know when I have published a new wound blog article. I am pleased that the standards in wound care magazines (including Wounds, Today’s Wound Clinic, OWM, and Podiatry Today) have recently chosen to follow my tweets and I hope that you will also.

How do you connect to wound blog on twitter?

Twitter is a unique social media that can be reached by mobile phone, Internet, or through desktop interfaces such as Tweetdeck. To follow the wound blog tweets click http://twitter.com/woundblog .

VAC Therapy for the Treatment of Pressure Ulcers

V.A.C.® Therapy can benefit the closure of full-thickness pressure ulcers (stages 3 and 4). VAC Therapy can also provide an optimized wound bed for  surgical closure. Goals for closure include promoting perfusion and  granulation. Providing a closed, moist environment also helps the healing process.

Setting recommendations  usually start at 125mmHg. This, however, is only intended to help the clinician select from range of therapy options available based on the condition of the wound and the patients co-morbidities.

The KCI VAC Therapy Clinical Guidelines refers to several clinical considerations when working with pressure ulcers:

1. All patients require a detailed medical and nutritional assessment and any factors that might influence etiology and/or healing must be addressed, particularly the provision of adequate nutrition and appropriate pressure relief.

2. V.A.C.® Therapy is not a debriding tool and is not a substitute for effective surgical and/or other forms of debridement.

3. If the patient’s skin cannot tolerate frequent dressing changes, it may not be necessary to remove the entire drape. Instead, cut the drape around the foam, remove the foam, irrigate the wound as directed by the clinician, then replace the foam and reseal with an additional strip of drape.

4. Mulitple layers of the V.A.C.® Drape may decrease the moisture vapor transmission rate, which may increase the risk of maceration, especially in small wounds, lower extremities, or load-bearing areas.

5. Care must be taken to prevent further trauma and/or pressure when placing V.A.C.® tubing, particularly over bony prominences.

KCI, 2009. V.A.C. Therapy Clinical Guidelines retrieved from http://www.kci1.com/Clinical_Guidelines_VAC.pdf

Twitter and Wound Clinics a Unique Combination

Take a look at my article in Today’s Wound Clinic on how Twitter can help your Wound Clinic communicate more effectively. http://www.todayswoundclinic.com/twitter

VAC Drape Application (Step by Step)

Placing the wound VAC drape is the important technique to learn. If the drape is incorrectly placed there is a risk that the VAC therapy will not work. Before placing the drape do a careful assessment of the Patient’s peri-wound skin, insuring that it is appropriate for drape placement. Follow these KCI VAC Therapy Clinical Guidelines to secure the drape and SensaT.R.A.C.®/T.R.A.C.® PAD:

Drape Application.

1. Trim and place the V.A.C.® Drape to cover the V.A.C.® Foam Dressing and an additional 3-5 cm border of intact periwound tissue . Drape may be cut into multiple pieces for easier handling, retaining a portion of the Blue Handling Tab on each piece. Use any excess drape to seal difficult areas, if needed.

2. Partially pull back one side of Layer 1 to expose adhesive. Be sure to hold Layer 1 flap back to prevent readherence to drape.

3. Place the adhesive face down over foam and apply drape to cover foam and intact skin, ensuring drape covers at least a 3-5cm border of intact periwound tissue.

4. Remove remaining Layer 1 backing material and pat drape to ensure an occlusive seal.

5. Remove green-striped stabilization Layer 2.

6. Remove perforated Blue Handling Tabs from drape (KCI, 2009).

Tract Pad Application.

NOTE: Do not cut off the pad or insert the tubing into the foam dressing. This may occlude the tubing and cause the V.A.C.® Therapy Unit to alarm.

1. Choose pad application site. Give particular consideration to fluid flow, tubing positioning to allow for optimal flow, and avoiding placement over bony prominences or with increases in the tissue.

2. Pinch drape and cut a 2cm hole through the drape (not a slit). The hole should be large enough to allow for removal of fluid and/or exudate. It is not necessary to cut into the foam.

NOTE: Cut a hole rather than a slit, as a slit may self-seal during therapy.

3. Apply Pad, which has a central disc and a surrounding outer adhesive skirt.

a. Remove both backing Layers 1 and 2 to expose adhesive.

b. Place pad opening in central disc directly over hole in drape.

c. Apply gentle pressure on the central disc and outer skirt to ensure complete adhesion of the Pad.

d. Pull back on blue tab to remove Pad stabilization layer.

NOTE: To prevent periwound maceration with wounds that are smaller than the central disc of the Pad, it is very important that the central disc lay on top of foam only. It may be necessary to augment the V.A.C.® Dressing with an additional piece of V.A.C.® Foam cut 1-2cm larger than the diameter of the central disc (KCI, 2009).

KCI, 2009. V.A.C. Therapy Clinical Guidelines retrieved from http://www.kci1.com/Clinical_Guidelines_VAC.pdf

Wound Care Tool Kit (Stoma Paste)

Stoma Paste is a very useful tool when trying to provide a uniform surface for the placement of wound VAC drape over uneven surfaces. Uneven surfaces include skin folds, incision line deformations, or anatomical irregularities related to surgery or trauma. There are many brands of stoma paste available, but I have had good luck with Convatec and Hollister Brands. I recommend using the following process to prevent the paste from doing what it does best – sticking to everything.

1. Prewarm the past in a tray of warm water for a few minutes to make the paste less thick

2. Squeeze a little paste out on the clean side of the opened VAC kit package (let it sit for about a minute).

3. Pour a little water or normal saline into an appropriate container.

4. Dip into the water with a wood depressor or the back of the 10 blade scalpel (that you are using to cut the VAC foam)

5. Take up the stoma paste with the moist utensil surface and place it into the uneven surface. Leaving the top of the stoma paste even with the corresponding topside tissue. If you need to add more paste remember to re-moisten the utensil or else it will stick fast to the applicator.

6. Smooth out the paste between the inserted stoma paste with the corresponding topsided tissue by re-wetting the utensil and gently moving across it surface.

7. Wait a few minutes for the paste to firm and then apply the VAC drape over it. If you don’t wait for the stoma paste to firm up the VAC suction could pull it in, which could loose the seal.

VAC Therapy for Chronic Wounds

V.A.C.® (VAC) Therapy can be used to close the chronic wound or to optimize the chronic wound bed before surgical closure. Goals for the treatment of the chronic wound include: promoting the formation of granulation tissue, promoting perfusion, providing a protected moist wound healing environment. KCI VAC Therapy Clinical Guidelines suggest that settings should first start with an initial cycle: which is “continuous for the first 48 hours. Note: consider intermittent therapy after 48 hours (5min ON/2 min OFF) if patient can tolerate (Pain with restart,high drainage (so the drape does’t wash out), loss of foam contraction and stability advantage”. Target pressure depends on each type of foam including: “V.A.C.® (VAC) GranuFoam Dressing 50-125mmHg (preferred pressure is 125mmHg) andV.A.C.® (VAC) WhiteFoam Dressing 125-175mmHg.Remember to change the dressing every 48-72 hours. If infected change the dressing more frequently” (KCI, 2009).

Note: Recommendations are expected to be used as a therapy ranges depending on wound etiology.Consult the physician or physicians order to verify settings for each patient.  Clinical Considerations for chronic wounds should include: Tissue biopsy and definitive lab testing to  identify any underlying etiology, Use relevant measures to treat the underlying disease processes, Consider aggressive debridement. Use care to prevent furtherV.A.C.® (VAC) related trauma related to tubing, especially at bony prominences (KCI, 2009).