Reducing pain during VAC Therapy dressing changes is a common challenge for clinicians. KCI’s VAC Therapy Guidelines provide useful strategies for how to reduce pain during a VAC dressing change: “First, if the patient complains of discomfort throughout therapy, consider changing to V.A.C.® WhiteFoam Dressing. Second, ensure the patient receives adequate analgesia during treatment. Third, if the patient complains of discomfort during the dressing change, consider premedication, then use of a non-adherent interposed layer before foam placement and/or the instillation into the tubing or dressing of a topical anesthetic agent such as 1%lidocaine* before dressing removal. Note: a sudden increase or change in the character of the pain requires investigation” (KCI, 2007).
For patients with fragile skin or patients who can not tolerate drape removal consider these tricks. First, use dressing or tape remover wipes to work under the drape. As you move the wipe under the drape pull the drape away from (not up from) the center of the dressing. Apply light pressure ahead of the elevated aspect of the dressing so you don’t pull to much drape to soon. Applying light pressure in this manner also helps to defer the sensation of discomfort in this area. Continue this technique slowly and take breaks as need. Secondly, it is permissable to cut the drape around the foam and just remove the foam (If the drape is still intact). Replace foam and cover the old drape and new foam with another drape. The underlying (older) drape in periwound area can only be left on for one additional dressing change. Finally, consider premedication with a pain reliever prior to the dressing and drape removal.
Note that “multiple 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” (KCI, 2009).
KCI, 2007. V.A.C. Therapy Clinical Guidelines retrieved from http://www.kci1.com/Clinical_Guidelines_VAC.pdf
*Lidocaine (topically) 3mg\Kg q2 hours
Lidocaine example:The max dose of a 150lb (70kg) patient with 1% lidocaine equals 21cc every two hours .
(Lexa-Comp. Drug Information Handbook. 12th Ed. 2004. 860- 862)